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While the whole country is reeling from the effects of COVID-19, it's safe to say that nobody has been braver during this whole crisis than the front line healthcare workers. They're the ones risking their own lives, day in and day out, to make sure the rest of us are safe; even beyond the physical risks are the risks to their mental health. In Wuhan, China, for example there were increased rates of anxiety, depression, insomnia, and PTSD among healthcare workers.
So, who is taking care of those who take care of us?
Last month, Vator, along with HP and UCSF Health Hub, held its second virtual salon of the year, centered around mental and behavioral health, which included Dr. Todd Czartoski, Chief Medical Technology Officer at Providence Telehealth. He spoke repeatedly about the ways that Providence, which he noted "is one of the largest nonprofit health systems in the United States," with 51 hospitals in seven states, and over 1,000 clinics, is doing to help its own doctors.
The company is taking a "multi-pronged approach to mental and behavioral health," he said, including its virtual behavioral health product, which it launched last year after the company's own health plan requested it.
"They said, ‘We don't feel like we’re doing a great job of caring for our own providers and caregivers, particularly when it comes to stress and burnout. You’ve done all this stuff in telehealth, can you build us a platform for behavioral health?’ So, we did; we spent about 18 months on what we call our 'Behavioral Health Concierge,' and we launched it last June," Czartoski said.
While it started out with 100 patients in the Seattle area, the service grew rapidly, with the company having around 1,000 patients by the end of 2019. The most interesting thing about it, though, was that 21 percent of those who were using the service were physicians themselves.
Czartoski noted his surprise at that number, simply because physicians are a group that "are notoriously difficult to get to ask for help," but there were some solid reasons for physicians to come looking for help, even before COVID hit.
"Part of the trigger for this was we had some suicides; we had burnout scores of 50 to 60 percent, just like the rest of the country, and that seemed to be getting worse, not better," he said.
He also noted that a big issue was how long it took to get an appointment before the program was implemented, making it difficult for healthcare workers to get help.
"On average, our response time was about eight days to when you could to someone. If you think about being in crisis, or having a really bad shift in the ICU or the ED, and the response is, ‘We’d love to talk to you, the first availability is eight days from now,’ you can imagine why our scores weren’t great and why we felt like we weren’t addressing the need. So, we were able to reduce that down to zero days," he said.
"By launching an on demand service that’s led by counselors, not psychiatrists, as the tip of the spear, we were able to see about 65 percent of patients same day, or caregivers same day, and essentially 100 percent within 48 hours, based on their preference."
That service was pre-COVID; since COVID has hit, things have only become more difficult for healthcare workers, with an increased amount of PTSD, which Czartoski blamed on the nature of the disease itself and how it presents itself.
"Dying from acute respiratory distress, respiratory failure is not a pleasant thing, and for front line caregivers, nurses and physicians, seeing that multiple times a day, day in and day out, just takes a toll. Lack of PPE, stress around not having enough masks and protective equipment has been a big stressor," he said.
To help alleviate some of those concerns, Providence has been able to cut down on the use of PPE by 50 percent per hospitalized day, per patient simply by giving iPads to patients. That means having fewer people going into the room, including nurses, reducing the risk of infection while also not requiring them to use a new set of gloves, gown and mask every time they want to talk to a patient.
On top of that, it also fosters better connection with the patient, Czartoski noted, who feel more comfortable talking to someone who isn't wearing protective gear.
"We can connect better with patients by using a virtual visit from outside the room, when I’m not wearing a mask and I’m not wearing a gown, and I don’t look like an alien. If you’re sitting in a room by yourself, day in and day out for a week, 10 days straight, and the only thing you see if someone who’s in protective equipment head to toe, it’s a very isolating feeling. So, provisioning them with a tablet, and the ability to connect with family members and their nurse, who’s on the other side of the wall, but is not covered in protective equipment, can actually really help that sense of isolation for these patients."
The other way that Providence has been keeping safe, physically and mentally, is by helping them keep their jobs by converting them into virtual care workers. That means that they can still see their patients, and don't have to have the added stress of reduced income, but they also don't run the risk of being infected.
In just one day, Czartoski said, Providence was able to take 7,000 providers and convert them to virtual providers, even ones who had no experience working that way before.
"We had a lot of providers who, historically, had zero interest in telehealth virtual care. In fact, they were antagonistic about the whole concept, and now are suddenly knocking on our doors saying, ‘Why can’t we get this faster?’ because they weren’t able to care for their patients the way they were for the last 20 or 30 years."
(Image source: aamc.org)
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