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Stories: Voices from the frontline

Elizabeth Wako, M.D.

One of the greatest challenges of navigating the pandemic this spring, according to Elizabeth Wako, M.D., was that we didn’t know what we didn’t know. Thanks to a system already put in place to deal with emergencies, though, we were able to quickly adapt.

And through that learning process we discovered how to both respond in the event of another wave and improve how we care for you under normal circumstances. “We’ve advanced health care 10 years in the last two months,” Dr. Wako says. The chief medical officer for Swedish First Hill explains how the pandemic is propelling our efforts to provide health care of the future.

If I had asked you in January whether we were ready to respond to a pandemic, what would you have said?

Honestly, I would have said, “No. I do not think we're ready to respond to a pandemic.” There are many things we are capable of responding to very quickly, like a mass trauma event or an earthquake. A pandemic, though? I can't say that we had a playbook for that.

However, what we did have was our hospital incident command system, or HICS, which is a framework for thinking and managing. It’s a way of organizing our hospitals and tiering up communication—because the key to navigating any crisis is communication. We do simulations all the time to practice for emergency events, like, say, an earthquake, which tests our ability to work as a team and fine-tune our structures. So we may not have had a playbook for a pandemic, but we did have a system for dealing with any significant event.

What, if any, good came out of this experience? What did we learn about how we deliver health care and how we could improve it?

I would say telehealth has been the number one benefit to come from COVID. If you had told me in 2019 that we would be able to deliver almost one hundred percent of our primary care visits by telehealth one year later, I would have thought you were crazy. But we did it. Our caregivers were motivated, our physicians were motivated, our patients were motivated.

We provided both acute care and triaged telehealth services. We provided telemedicine to other hospitals. We set up drive-through testing clinics and locations, and we set up home kits where our patients were given self-monitoring tools. These were patients who either were COVID-positive or high risk of being COVID-positive but weren't sick enough to be in the hospital. They were given a pulse oximeter unit and a thermometer, and then we sent them home to be monitored by telehealth. So it is amazing the amount of remote care that was developed in a two-month period.

We’re already starting to see COVID infections tick up again in Washington state. How much better prepared are we in the event of a second wave?

First of all, we have a very robust supply chain now for PPE supplies, and we have storage facilities and places to manage our COVID supplies that we didn't have before.

Second, we have designated COVID units, and we have a greater understanding of our capacity for staffing and how to separate our COVID patients from our non-COVID patients. The third thing we have is really good screening mechanisms for both staff and patients at our hospital entry points. And that has continued to this day. We haven't let down our guard.

We’re also better prepared to communicate to our patients that it’s safe to come to the hospital. Too many patients didn’t come in when they were having chest pain, when they were having stroke patients. Those are the patients we want to make feel safe about coming in, should there be a second wave.

Based on what we’ve learned from this situation, as you look to the future, how might the patient experience look different five years, 10 years, 20 years from now?

I see us reaching a point where we can completely manage our patients at home, unless they need a high level of care. I expect that we’ll streamline that service—and not just for a pandemic, but also for regular visits under normal circumstances. I imagine we're going to get to a point where one in two patient visits will be handled via telehealth.

I also see us getting to a place where we're able to deliver almost hospital-level care at home. Take, for example, how we were able to send COVID-positive patients home with self-monitoring tools. They were capable of following pretty elaborate direction and keeping track of their symptoms, calling in and speaking with a nurse. We were able to safely provide care for thousands of patients at home by giving them the equipment and a way to connect with us immediately.

I can see some patients being a little intimidated by that: “Wait, I have to be my own nurse? I have to take my own vitals?” What did we learn about coaching patients through that?

We learned that patients are much more resourceful and capable than they give themselves credit for. Both the patients and their family members are really quite resourceful.

Under normal circumstances, fear would make patients unsure and less likely to want to take on a self-monitoring situation. They'd be more likely to want to be admitted to the hospital. Ironically, the perception during the pandemic that the hospital was in some way less safe—even though it was probably the safest place you could be—encouraged our patients to have faith in themselves and their ability to care for themselves. And they really did.

And patients weren’t the only ones who questioned whether they would feel connected to their provider by video. Caregivers felt the same way. I think all of America learned a lesson through this experience, though. Just think of how many people who used to have family dinners on Sunday are now doing a Zoom meeting instead. It’s just a part of our lives. We’ve advanced health care 10 years in the last two months.