Preparing for the COVID-19 Rush With the Medical Director of Georgia’s Surge Hospital
In April, state officials in Georgia decided to open a 200-bed facility at the Atlanta-based Georgia World Congress Center that would serve as a surge hospital for COVID-19 patients who were sick but didn’t need intensive care. Fortunately, the patient care facility in Georgia was barely used, housing just 17 patients before being temporarily shut down.
Bryan Harrell, D.O., was tapped as the acting medical director for the Georgia World Congress Center COVID-19 surge hospital, and recently answered a few questions over e-mail related to the process of opening the facility, bringing together a team of healthcare professionals, experiences from the trenches, caring for COVID patients, and more. Below are excerpts of that discussion.
Editor’s note: given the recent rise of cases in the South—Georgia has now eclipsed 100,000 confirmed cases with the state’s hospitals reporting fewer open beds—the Georgia World Congress Center is being reactivated as a COVID-19 overflow facility. Dr. Harrell was interviewed before the reopening of the surge facility.
Can you describe your role as medical director for the Georgia World Congress Center COVID-19 surge hospital?
The 200-bed surge hospital opened in mid-April as a safety net for patients throughout Georgia with COVID-19. The influx of patients with the virus had the potential to overwhelm the state’s hospitals, so it was put in place to manage overflow. Patients we cared for were not in need of critical care, however many suffered from multiple co-morbidities that made treating their infection more complex.
In my role as medical director, I had to not only make sure each admitted patient received the best care possible, but also lead a team of clinicians who were brought in from all over the country to supplement the state’s existing medical resources. These were men and women on the frontlines of a novel virus with limited evidence to support treatment decisions and varying experience and perspectives. While everyone was there for the same reason—to care for patients—it was sometimes a challenge to align perspectives and treatment best practices.
Has the surge hospital been leveraged to accommodate patients? If so, what has that process been like?
Fortunately, Georgia was starting to experience a leveling out of cases across the state when we opened. The surge hospital [ended up housing just] 17 patients total. Additionally, many hospitals in the area were able to leverage beds typically used for elective surgeries for COVID-19 patients. That said, all the patients we treated had come from other hospitals. Some had been on ventilators or in critical condition but were starting to improve. They no longer needed oxygen or drips, but still required medical attention. This is where we came in.
One of the biggest challenges we faced was managing the patients’ chronic conditions along with COVID-19. The challenge was made more complicated by the fact that very little was known about treating COVID-19. Even in April, it seemed like treatment protocols were changing every day. I felt like our job was to treat the conditions the patients had to the best of our ability.
Can you detail the process associated with bringing together a “surge team” of different clinical professionals? Was that challenging?
I have a military background, so I liken it to a high-speed deployment. Whenever my unit would deploy, we typically had six to nine months to adjust to personalities, gel as a group and understand the expectations. In this case, we had just three days to get up and running so everything was fast-tracked.
The surge team consisted of 211 medical personnel and 10 people to support administrative needs. The medical team was made up of physicians, nurses, RNs, LPNs, certified medical assistants, paramedics and even EMTs.
Everyone had a role to play, but I spent a lot of time trying to rein in everyone given their unique backgrounds. We leveraged UpToDate, a trusted clinical decision support tool from Wolters Kluwer, to get everyone on the same page with evidence-based information. A number of clinicians asked up-front if we’d have access. It was hugely valuable because it was a centralized resource at our fingertips that was constantly refreshed with the latest clinical evidence and CDC guidelines and protocols, which were changing all the time. It became the go-to resource for the clinical information our providers needed at the point of care to make quick but informed decisions.
From a physician’s perspective, what advice can you offer for treating COVID-19 in patients with co-morbidities?
Many of the patients we treated at the surge hospital had numerous co-morbidities and were on upwards of 10 medications. One older gentleman I recall had diabetes, hypertension, dementia, chronic kidney disease and cholesterol issues. In these instances, we had to employ a more holistic approach and pay close attention to the medications these patients were on to avoid an adverse drug event.
Which technologies/innovations would you like to specifically call out that have aided your team in the fight against COVID?
UpToDate was truly a guiding force in getting our clinical team up and running to treat our patients. The tool is used and trusted by so many clinicians around the world that everyone was familiar with it and, perhaps more importantly, understood the rigor that went into the clinical guidance it provided. At a time when information was coming from all directions and misinformation was rampant, it was reassuring to have a centralized tool that we knew contained thoroughly vetted information we could use.
From this experience I have seen firsthand just how effective technology can be for gaining consensus when leading a team of clinical professionals with different perspectives and in ensuring a high standard of quality care.
