Bomi Bhote
Ruby Hall Clinic, Pune

Weathering the COVID-19 storm–The new face of healthcare delivery

The tsunami-like impact of a global pandemic has a way of drowning out foresight. Right now, it feels impossible to predict what the world will look like next week, let alone next year. Yet medical science and the broad sweep of history suggest that COVID-19 will transform lives in the long run. The changes in progress–some predictable, others still hard to fathom–started brewing as soon as case counts began to escalate and panic began to set in. But the reality is that in most hospitals around the country, it was actually somewhat calmer than usual.

Elective surgeries were cancelled to make space for the expected surge in admissions, driven by the pandemic, and doctors began going through outpatient schedules for the next few weeks, identifying which patients really needed to come in and who can be cared for just as well virtually. This calm made sense given the mandate for social distancing, working from home, and canceling nonessential activities. What did not make sense is this–in the emergency departments, daily patient visits significantly decreased.

Even today, the worry is that patients are ignoring their symptoms, and dangerously delaying life-saving treatment over fears they may contract coronavirus within hospitals. Strokes and heart attacks do not take a vacation just because there is a pandemic. They are still happening. They just are not happening as much inside the hospital, which is a major concern. Appendicitis, dialysis, and acute psychiatric problems are among other concerns.

The truth is that we have made accommodations for COVID-19 to ensure that we can also care for the other healthcare problems we come across every day, and do it safely. We are actively redesigning the way we deliver care to do what is best for our patients during this time of crisis. Some aspects of that redesign will likely persist after the crisis has passed. Amidst this immediacy, it is important to begin to consider the less-urgent-but-still-critical question of what the Indian healthcare system might look like once this has passed. In particular, what can we learn from the existential challenges we face?

Safety protocols are here to stay
Currently, we are screening every person at Ruby Hall Clinic for symptoms before entering facilities. These screenings take place at the time of entry, whether the individual is a patient, a visitor, or a staff member. Onsite screenings require all patients, visitors, and team members to sanitize their hands, answer questions about potential symptoms, infrared temperature checks, and wearing a mask.

Patient segregation will continue
Besides screening every person entering our premises, is segregating COVID-19 positive patients, restricting them to a single building within our premises–with dedicated critical care monitoring as well as operation theaters. We are very conscious that a lot of patients may be asymptomatic carriers of the virus and that strict screening and segregation is the only way to continue flattening the curve.

Maintaining physical distancing during in-person visits
We are spacing out appointments, increasing virtual visits with telehealth, and expanding hours where appropriate. This way, we can accommodate more patients while limiting the number of people in our hospitals at one time. We are also rearranging our waiting rooms to encourage physical distancing.

Elective surgeries will take center stage
We have implemented several processes in addition to the measures above for ensuring everyone is safe during surgical procedures that take place in our hospitals and ambulatory surgery centers. These include performing multiple screenings of patients at the time of scheduling, on pre-visit calls, upon arrival to the building, and at check-in, as well as a pre-surgery COVID-19 fitness test.

Adoption of telehealth
We are offering the option of telemedicine across a number of specialties even as part of large health systems that had previously not offered this. The coronavirus crisis marks a before and after in telemedicine–we have seen the value of telemedicine for saving time and money. Isolated patients are able to communicate with their families with tablets and mobile phones; and doctors are monitoring vast numbers of patients that are convalescing at home.

Precision medicine will be more than just a buzzword
Imaging sciences are likely to play crucial role by virtue of early disease detection, monitoring, and image-guided targeted therapies with use of anatomical, functional and molecular imaging, and integration of data. Moreover, advanced technology and AI-guided therapies are no longer just futuristic; they are today’s realties and are here to stay. Precision medicine gives patients the benefit of quicker, more efficient recoveries, and must be implemented to help reduce hospital stays and improve patient well-being. Our hospital has always been a hub for state-of-the-art treatment options and we have taken it upon ourselves to encourage patient receptiveness toward novel treatment options.

Reorganization of the supply chain
As a country, this pandemic has allowed us to shift focus to what matters the most when it comes to the continued delivery of healthcare–logistics and the medical supply of drugs, PPEs, and technology. It is an onus that lies on our shoulders. We must come together as an industry and shift our focus from being reliant to self-sufficient. We have the talent and the manpower, and now we have the motivation.

Inpatient care will remain
Inpatient care is still a bedrock of almost all health systems, but its role in the care continuum is changing dramatically. We are seeing a lot of consolidation of services, greater connectivity among health systems, and some shrinking of services, yet the demands of communities will still be as great as they have been in the past.

The continuum of care must be maintained 
In a country bound by the shackles of a growing number of lifestyle diseases, patients suffering from ailments such as cancer, renal failure, hypertension, cardiac disease, and even certain neurological conditions need to understand that prompt and continuous treatment must be meted out to keep conditions from worsening. As a hospital, we are doing all we can to keep our health check centers, laboratories, OPDs, and emergency departments safe and available to every single person–be it by continued disinfection, spacing out of appointments, and even by maintaining the norms of social distancing.

Fear should be replaced by hope
Stepping out of the pandemic and into a new sense of normal may be all the rage, but the fear that has been set in the hearts and minds of our patients needs to be addressed. We need to reinforce the notion that hospitals are not hubs of infection, but safe havens once more. At Ruby Hall Clinic, we have undertaken countless initiatives to help inculcate the sense of hope, health, and healing within our walls. These initiatives cases of success, expert opinions and other forms of positive reinforcement.

We are all moving forward with huge hope that the dust will soon settle over the widespread devastation caused by COVID-19 pandemic and that the world will once again have some semblance of normalcy. But what we must understand is that there is no going back from here, this is the new normal–this is the present, and what seems to be the very foreseeable future. As a healthcare institution, we have experienced time and time again that after devastation comes hope. The cycle of life brings forth the virtue of change. And it is adapting to these very changes that will help us brace for future pandemics, and for the future of healthcare at large. 

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