Over the past two months, the Generalist Firm within Yale New Haven Hospital (YNHH) has changed drastically. Led by Firm Chief, associate professor (general internal medicine), the Generalist Firm cares for patients admitted for general medicine needs who receive their primary care from the Yale New Haven Hospital Primary Care Center (PCC) or Yale Internal Medicine Associates (YIMA) as well as for other YNHH general medical patients.
The firm is historically located on East Pavilion 9-5, a 28-bed unit, adjacent to the Donaldson Firm, which focused on infectious disease and general medical patients. In mid-March, COVID-19 patients began to be admitted on the Donaldson service. To assist their colleagues, Generalist attendings and residents created a workflow to transfer the patients who were determined to be COVID-negative into their self-created ‘step-down unit.’
A few weeks later, the service was relocated to 4-6, where more innovation was underway. Shortly after this move, medicine residents were pulled from each unit and relocated to North Pavilion to care for the influx of COVID-patients. Advance practice providers (APP) from the YNHH Hospitalist service stepped in to partner with the Generalist team to care for patients on the service.
“This change was a challenge,” said Berland. “Fortunately, the Hospitalist service and APPs are amazing. I can’t give them a big enough shout out for their efforts.”
The firm got house staff back when it transitioned to COVID-positive patient care in April. To support this transition, Berland started hosting a Sunday afternoon Zoom meeting to brief the incoming physicians about additional COVID-related information they would need to consider such as how to obtain COVID testing, how and where to put on their personal protective equipment (PPE), and what is the decontamination process when you leave the hospital. Even things as simple as where do obtain water would need to be considered. The physicians coming off service shared tips and tricks for the team starting their rotation. Berland also helped physicians secure hoteling and Mobile Heartbeats if needed.
“All those things that we once took for granted, we now had to talk through,” said Berland. “We came up with new ideas. Out of these observations, innovations has come out of it.”
Many new workflows and innovations have come out of these brainstorming calls. The group created a “PPE mudroom”, a specific room where caregivers can put on and remove their PPE, which includes a mirror so they can see that it is applied properly. They bought plastic containers to store their N-95 masks. One physician noticed a patient was afraid and isolated, so he started to play music to raise their spirits. Another patient loved Baked Cheetos, which a physician obtained for the patient. Care Coordination rounds are now held over Zoom. Even the day-to-day attire was changed to scrubs.
“The attendings came up with innovative ideas because of COVID, which has been really cool. My job is to support the firm and to create a platform so that people can do their jobs. And along the way, there's been some really innovative things that we've been able to implement,” explained Berland. “Even though I get to wear the firm hat, the firm is really representative of a larger community of really amazing people.”
“Gretchen has provided truly inspiring leadership to our Generalist Firm,” said, Dan Adams and Amanda Adams Professor of General Medicine and chief of General Internal Medicine. “Her careful attention to detail while addressing ‘big picture’ issues in a thoughtful and comprehensive manner in collaboration with our faculty, house staff, hospital medicine staff, and nursing staff has provided a wonderful model of highly effective leadership for the COVID pandemic. Our patients have greatly benefited as a result. Bravo!”
The Section of General Internal Medicine is committed to the core missions of patient care, research, education, and community health from the “generalist” perspective and is one of the 11 sections with the Department of Internal Medicine. To learn more about their mission and work, visit.