One Crisis Prepared Us for Another

Last July, Hahnemann University Hospital suddenly closed its doors. There was little warning; there was only a constant influx of patients through the revolving doors of our emergency department—patients with no records, no neighborhood hospital, and no place else to turn.

As an enterprise Jefferson rose to the occasion and acted quickly to accommodate the volume of sick and injured flooding our emergency department. We had to rethink the way that we utilized space, people, and resources. Every division devised and swiftly executed best practices plans across the board. We made changes to pathways on the fly daily, if not hourly. We implemented flows and novel processes as we moved forward. Sometimes we felt like we were under water as the patients kept coming, but the resiliency, the ability to pivot, to think creatively, and not only to think outside of the box but literally to be out of the box was remarkable.

Little did I realize at the time that the Hahnemann closure was a dress rehearsal for what was to come.

Just as we handled a record-breaking ED volume day at Center City—about 300 patients in 24 hours—a global health crisis landed at our door. In January, the world started seeing the beginnings of COVID-19, a virus that would spread like wildfire, turning into a pandemic in just a few weeks. The Philadelphia region saw its first patients in March—and Jefferson was ready.

While the closure of Hahnemann was a great tragedy for our region, it offered us an unanticipated opportunity to get our house in order from top to bottom. The lessons we learned from Hahnemann allowed us to properly strategize for the COVID-19 crisis, and to put plans into place that allowed us to prevail in this ever-evolving emergency situation.

The Hahnemann closing and COVID-19 were similar in many respects: both situations came about fairly unexpectedly and hit the emergency departments first. But there were differences, too. We knew that Hahnemann closing might be coming, but thought we had months to prepare. We were taken by surprise when they closed their doors overnight, and we suddenly had 50 to 100 more patients a day. With COVID-19, we knew the patients would start trickling in, and that eventually there would be a surge. Our processes and pathways were actually in place about two weeks ahead of the predicted volume and surge. The sky was going to fall, but we were prepared to catch it.

However, while we had prepared for COVID-19 as far as facilities, staffing, and procedures, nothing could have prepared us for the disease itself or the challenges it would present. When we were in the thick of the Hahnemann closure we were dealing with the sheer volume of patients, the challenges of not having their medical records, and not having enough staff. It was foreboding, but these weren’t scary patients; they didn’t have a disease we had never seen before.

This is much harder than anything I’ve ever done in my career; for the first time I felt uncomfortable, out of my element. The ED is supposed to treat chest pain, broken bones, the flu—not particularly frightening conditions for providers because we are used to them. But now we are facing an unknown enemy, and we don’t know what to do with it. We are using equipment we’ve never used before. We are working in gear we’ve never worked in before. Unlike the average patient who comes into the ED, COVID-19 patients are highly contagious with a deadly disease for which there is no proven cure or vaccine. Caring for them means donning gowns, masks, gloves, and other protective gear; it means sometimes not eating or drinking or using the bathroom for an eight-hour shift because you don’t want to get in and out of your gear; and it means knowing you could contract the disease, and pass it onto family.

There is no book on COVID-19. There is no blueprint for what works and what doesn’t. We are taking our best guesses clinically. But because of the dress rehearsal—because of the Hahnemann closure that forced us to reimagine and restructure healthcare processes and pathways—Jefferson is one of the most prepared systems in the region, perhaps even in the country, to handle the pandemic at our door.

Jennifer L. White, MD
Associate Professor, Dept. of Emergency Medicine
Associate Medical Director
Assistant Program Director
Sidney Kimmel Medical College