State-Wide Leadership and Partnerships in New Haven

Transcript

• 00:03Thank you very much. Sorry I would like to introduce our next speakers for us.
• 00:10I'd like to introduce Marna Borgstrom,
• 00:13who served as chief executive officer of the Yale
• 00:16New Haven Hospital and Yale Health since 2005 bulbs from received her undergraduate degree from Stanford University.
• 00:23She received her Masters of public health by the Yale University School of Public Health where she is also in our lecturer and from where she recently received the Distinguished
• 00:35Alumni Award. In 2018 we also have Vincent Petrini,
• 00:40senior vice president of Public Affairs at the Yale New Haven Health System.
• 00:46Between earned his master's degree in communications from Northwestern University in 1993.
• 00:52In 2003, he joined Yale,
• 00:55New Haven Hospital and is currently responsible for marketing,
• 00:59communications and government media and community relations.
• 01:02Thank you both for being here.
• 01:09Thank you, thank
• 01:10you, thank you very much,
• 01:13Daniel. For that kind introduction.
• 01:15And as we put this together and I was contacted about this,
• 01:20I thought that what Vin and I could do is tell you a little bit about the work that we've done,
• 01:29consistent with Dean Brown's introduction to partner at the statewide level and at the local level.
• 01:36Because, you know, this is certainly an unprecedented pandemic.
• 01:40And it literally takes a village and then some to put together our best response.
• 01:48So I'll start by way of saying that several weeks ago,
• 01:55the Governor, Governor Lamont called me and said that he wanted to stand up a statewide task force that would look at the appropriate capacity,
• 02:09care and. Follow up for people in Connecticut with COVID-19 and he asked if I would Co chair that task force,
• 02:19which I was delighted to do and with colleagues who run Hartford Healthcare an new vans health which is in both Connecticut and in New York State.
• 02:32What we set out to do was understand the models that were out there as best we could.
• 02:41For how this pandemic could likely impact the state of Connecticut,
• 02:47Anna's most of you have probably seen there were wildly different projections.
• 02:53There were some projections that showed that instead of the.
• 03:00Then I guess it's 55 or 5800 beds that we have in the state of Connecticut that we were going to need close to 10 times that number of beds
• 03:11to deal with the number of people who are going to become seriously ill.
• 03:18With COVID-19 uhm, all the way down to models that showed a longer tail to this disease,
• 03:26but a far lesser slope of incidents,
• 03:30so getting our arms around the models which we did first by trying to understand the models and 2nd by looking at what our own experience was on a day
• 03:44by day by day basis,
• 03:46which has been very. Instructive the second thing that we did was given those models,
• 03:53try and understand not just where we could create additional inpatient capacity,
• 03:59but what that capacity needed to look like.
• 04:03An while. Many of the people who are watching this may have seen that there was a.
• 04:11National Guard 600 bed facility set up at the more Fieldhouse at Southern Connecticut State University and there are beds available at the Lannom.
• 04:25Center at the Payne Whitney gym.
• 04:27Uh, what we felt particularly for Yale,
• 04:30New Haven Hospital and in fact for all of our hospitals in the health system was that we could provide far better care for these patients given what we expected
• 04:41their needs were going to be by first turning every Nook and cranny that we could within the four walls of each of the hospitals into active patient care space,
• 04:53because these additional resources. Well,
• 04:56nice to have if the absolute worst happened,
• 04:59we're going to be very difficult to staff and very difficult to support with even basic needs.
• 05:05How were we going to toilet patients?
• 05:08How are we going to keep them fed etc etc.
• 05:12The other thing that we did with the statewide task force was looked at.
• 05:18The availability of Ventilators, an personal protective equipment and related equipment that we needed.
• 05:25How much of it we had,
• 05:27where it was an rather than looking at as as a proprietary hospital by hospital or health system by health system issue.
• 05:37Figuring out how we could make sure that those resources were available in the organizations an where the patients needed them most.
• 05:48The last thing that we wanted to look at was load balancing patient demand.
• 05:55We all have seen that the patient demand was greatest initially in Greenwich and then in Stamford and in Danbury.
• 06:04It's sort of followed the Ark of the commuter lines in Connecticut coming out of New York State,
• 06:12and it was remarkable in some ways that it was relatively slow to get.
• 06:19Even to northern Fairfield County to Bridgeport and New Haven,
• 06:23while Greenwich is an example at one point.
• 06:27Had more than 50% of their capacity taken up by very seriously ill COVID-19 patients,
• 06:34as did Stamford Hospital. And So what we.
• 06:40Also set up in this process was a regional incident command center that was led by one of our own physicians,
• 06:50doctor Victor Morris, who started our initial Y axis program and the purpose of that was to keep incident commanders in each of the delivery networks actively involved in communicating
• 07:04with one another about what the demands were,
• 07:08what their needs were for,
• 07:10either staff. Equipment and or for patient movement and what we've done successfully is re balance and move patients so that when Stanford was particularly busy,
• 07:22they had increased their intensive care unit capacity by threefold,
• 07:26but had gotten to the point where they had five ventilators not in use.
• 07:32What we did was started moving patients to Bridgeport to New Haven and even to New London to take some pressure.
• 07:41Off of their critical ventilator and ICU capacity,
• 07:45what we're seeing now is that while the number of cases is still growing in the state of Connecticut,
• 07:55that curve has flattened dramatically instead of in the early days when we were seeing Fort.
• 08:32Rayshon in the northern part of the state.
• 08:35Additionally, as we brought more as we have brought more than later and personal protective equipment into the state,
• 08:42what we've done is we've made sure that that's gone where the Cove it positive patients are now are at any point in time not.
• 08:53Allocated because of hospital or system ownership of any resources.
• 08:57The Governor of the state of Connecticut.
• 09:00Governor Lamont has been a phenomenal partner in all of this.
• 09:04He's been available. He's asked great questions.
• 09:07He he's listened to the advice he's gotten and he has been ever present and completely available to us and working on this,
• 09:17and I think it's been in my 40 plus years in Healthcare.
• 09:22The strongest partnership that we've ever had.
• 09:25With the state and among the institutionally based health care providers,
• 09:30what we've done is taken that and blown it up in a microcosm in the city of New Haven,
• 09:38which is the obviously home base for Yale University Ann for Yale,
• 09:44New Haven Hospital and developed a similar partnership with the very new mayor of New Haven,
• 09:51who was inaugurated and put in office in January.
• 09:55Never really had a lot of experience in elected positions and then found.
• 10:00Himself leading the city through this covert crisis.
• 10:03So I now like to ask my colleague been Petrini to describe the work that we did in partnership with the city of New Haven then.
• 10:15I think Marner can you hear me OK,
• 10:18great so let me just take a few minutes and I think with Marta outlined here was really important because I think when we face a situation like this which
• 10:29is very uncertain and unprecedented as the Dean said at the on set,
• 10:33the need to connect with our elected officials on a regular basis and by regular I mean in this case daily basis with state and local officials is really really
• 10:44critical because. His constant information flow back and forth really leads to inform decision making an I think the good news here is that everyone is trying to have the
• 10:54same goal is trying to do the same thing for the patients that we serve.
• 10:59The community that we serve.
• 11:00But sometimes there's a lot of moving parts and things evolve rather quickly.
• 11:04So in New Haven is Martin mentioned the mayor was,
• 11:07I think, inaugurated just as this virus outbreak in the US was ramping up.
• 11:12So while he served in an aldermanic capacity for many years and we knew him in that regard.
• 11:17This was a pretty extraordinary challenge to take on for new elected official,
• 11:22but I have to say,
• 11:24just like a Governor, Lamont has been the mayor's been very hands-on and very engaging.
• 11:30Very involved from the on set,
• 11:32and I think it's been very helpful because I think when there's been this shared decision making it leads to better outcomes.
• 11:40Overall, I can give you a couple of examples early on when we were talking about the extent of the exposure in the community.
• 11:50Everyone was trying to do the right thing.
• 11:52The governor had issued a number of executive orders and the mayor called us on Friday night and said that he was about ready and wanted to give me a
• 12:01heads up that we have already to issue an order that would cap daycare slots at 10 or less children and wanted to let us know before it took place.
• 12:10We had a great conversation that night.
• 12:12We talked about the fact that we might be significantly impacted.
• 12:15Our daycare at Yale, New Haven Hospital alone cared for about 140 children a day.
• 12:20And by capping it we would have lost access to that and access to healthcare workers that were on the front lines.
• 12:27And so we worked with actually Linda Mays and Walter Gilliam or great at the University.
• 12:31Kevin Myatt on our team.
• 12:33We spent the weekend working with the mayor back and forth to the point that Sunday night we were able to revise the executive order before it was issued.
• 12:42Put in language that exempted healthcare facilities in health care providers,
• 12:45which was also happen to be very consistent with what the governor had done.
• 12:50Earlier that week, so I think that that open two way communication was really helpful as we begin to shape policy.
• 13:02And we have actually a regular cadence with the city,
• 13:05you know, Martin, I every morning around 6:00 o'clock get an update from our incident command team that tells us really the number of in-house cases.
• 13:12A number of tests, the number of.
• 13:14Unfortunately, the number of related deaths,
• 13:16but also the discharge is it come out and we've been able to track that from Greenwich,
• 13:21which was really hard hit at the front in front end of this through Bridgeport,
• 13:25which is really impacted right now.
• 13:27Right into New Haven. At 9:30 we get together with all of our delivery networks are hospitals and they have the opportunity to update that information.
• 13:35About things like PP supply and raise any particular challenges we have,
• 13:39I get in a call at 10:15 with all the state agencies in the constitutional officers we hear what's going on around the state.
• 13:46What's going to happen that at that point in time and we share any issues that we might have during that meeting.
• 13:53And then at 1:00 o'clock we jump on a call with the mayor and his senior administration,
• 13:58including the chief of police that you fire in a number of emergency responders so that we can compare notes and talk about some of the special challenges.
• 14:07That happen in what they need from us and what we need from them.
• 14:12And then at 2:30 we doc back in with our own hospital Hicks briefing incident commanders night.
• 14:18You know we can relay information back to our our administrative leaders and that happens every day that happened Seven days a week and that's really important because as you
• 14:28know this this. This virus doesn't stop for weekends or Holidays.
• 14:32So we've been able to kind of sustain that level of communication.
• 14:36It's been instrumental. When the city at the very front end of this,
• 14:41we had a patient actually that lacked.
• 14:44The home setting was had been tested positive for Cove it and was being prepared for discharge in the patient eloped actually wound up.
• 14:55Going back to parts of the city in New Haven,
• 14:58there was great concern that this patient might be shedding virus and could impact other members of the community at that time.
• 15:05We work directly. It was a Sunday afternoon with Maritza Bond,
• 15:08who is the director of public health in the mayor.
• 15:11New Haven police were able to within a few hours,
• 15:14track down this patient. We actually found him in Milford,
• 15:17were able to quarantine him at a local hotel and work with the Milford public health director to make sure that that patient was not in a position to expose
• 15:26others. To raise the issue of challenging populations,
• 15:29and if those were on domiciled and need to be discharged from the hospital from the emergency room or an inpatient setting.
• 15:36How do we do that?
• 15:38How do we manage that?
• 15:39So the mayor tapped into his team?
• 15:42They activated career high school which is in between our two campuses and set up work with the Red Cross and set up about 50 beds in the gym.
• 15:52At Karere. They had a challenge around staffing so we had long conversations over a period of a couple days about how we could staff this.
• 16:02We talked about bringing in the National Guard in the medical reserve core.
• 16:07The mayor was able to connect with the governor's results out and we were able to staff that with several retirees.
• 16:14With clinical backgrounds that volunteer raise their hand to come in and it was really important because now even though we only have two to four patients there at any
• 16:23given time, those are patients that would have normally been discharged back to the community and could have potentially impacted others in the community.
• 16:30So you know, there's a lot of moving parts when it comes to this type of situation.
• 16:35There's no playbook that you can follow.
• 16:38Given the nature of this pandemic 'cause we're still learning about it as we move forward,
• 16:43so I think being in constant communication both at the state in the city level is important.
• 16:49We we actually work with our colleagues at Yale,
• 16:53Rich, Jacob and Lauren Zach are very well coordinated.
• 16:56Our efforts and enrich has been very involved with the state and the federal delegations coordinating all the information that we need to back and forth participating in town Hall
• 17:06meetings with Senator Blumenthal and Murphy and Rosa Delaura.
• 17:10And others has been important as well so is this is the virus continues to evolve and the challenge continues to persist and we see that impact here in New
• 17:21Haven I think the communication between our organizations and our elected officials the community representatives of public health directores governor's office is Mars already pointed out has been really instrumental
• 17:31to being able to drive not just actionable information and be able to make operational decision but begin to set the stage I think for long term.
• 17:41Policy considerations, which I think coming out of this is going to be really important as well.
• 17:47So there's a lot that continues to go on,
• 17:50you know, we've we've been very transparent as an organization,
• 17:53we had a small outbreak at Grimes,
• 17:56for example, we immediately worked with the Department of Public health here in New Haven.
• 18:01Worked with Maritza bond to make sure,
• 18:03and we cord that we were sharing information.
• 18:06There was an outbreak at Bella Vista senior housing area with 2000 residents in New Haven.
• 18:11We worked with Fairhaven Community Health Center and the city to try to address those issues,
• 18:17but. Ultimately, at the end of the day,
• 18:20I think it really just comes down to basic and in regular communication cadence between our organizations and those who are serving the community as well.
• 18:29That's great, thank you so much.
• 18:31Then an, uh, we're going to turn it back to Daniel and Yaacov to continue your agenda.