Implementation of COVID-19 Provider Resource Task Force: A provider support initiative during emergency preparedness in a quaternary-care center in western Michigan

OBJECTIVE
COVID-19 has placed an immense pressure on the healthcare systems across the world regarding development of protocols and initiatives to mitigate the spread. Clinicians are coping with enormous challenges to their professional commitment and the need to support them has risen more than ever during these unprecedented times.


DESIGN
We describe a support initiative implemented by Spectrum Health, a quaternary center in West Michigan to support providers across the community. COVID-19 Provider resource support tool helped clinicians across multiple other systems in the region with real time information about COVID-19.


METHOD
A COVID-19 provider resource workgroup was created with 18 physicians who volunteered to receive calls and emails from providers across the region over 8 weeks. The group aimed to be the real-time COVID-19 resource while clinicians are facing the pandemic in an ever-changing environment.


CONCLUSION
Providers have not faltered to embrace new responsibilities, implementing protocols and coaching their colleagues in response to COVID-19. Support initiatives like these while essential to maintain psychosocial health of the clinicians also reveals the true strength of professionalism amidst the pandemic.

To the Editor-On March 11, 2020, World Health Organization (WHO) announced coronavirus disease 2019 (COVID-19) a pandemic. 1 Spectrum Health System, like many other healthcare systems, activated an emergency preparedness command center and implemented strategies to mitigate the impact of COVID-19. Spectrum Health System is a nonprofit quaternary-care health system based in Grand Rapids, Michigan. More than 4,600 physicians and advanced-practice providers offer care to patients through 14 hospitals, including Helen DeVos Children's Hospital and 150 ambulatory clinics. Grand Rapids medical community also includes 2 other health systems, many ambulatory specialty and subspecialty practices, and rehabilitation units. During the COVID-19 pandemic, Spectrum Health initiated a work group as a support initiative for the patient-facing clinicians in the entire community.

Methods
The COVID-19 Provider Resource Work Group and hotline were commissioned on March 19, 2020. The aims of the work group were (1) to provide real-time provider-to-provider education regarding questions that pertain to COVID-19; (2) to respond to a COVID-19 e-mail inbox that received questions from 31,000 employees within the Spectrum Health System; (3) to enable triage providers to direct their patients to appropriate channels; and (4) to improve provider access to updates on testing, treatment guidelines, and web-based resources. In total, 18 Spectrum Health physicians from infectious disease, allergy and immunology, internal medicine, and pulmonary critical care, as well as infectious disease fellow physicians volunteered to be part of the work group.
Initially, clinical questions from all the providers across the medical community would go through the provider hotline. This hotline was attended by a nurse who directed the appropriate calls to the on-call physician from the work group. Physicians self-assigned themselves to 4-hour shifts 7 days a week from 8 A.M. to 9 P.M. on a secure HIPAA-compliant communication platform called Perfect Serve. A shared inbox "covid19dr" was attached to the physicians' personal organization e-mail to receive questions. After an initial meeting that was organized to review the goals and objectives, the work group communicated daily to discuss the challenges, work flow, and current literature. Physicians self-educated on the current literature by reviewing Spectrum Health LitCovid, an internally created database maintained by the research department. No additional financial incentive was provided to the physicians; participation was voluntary.
The calls and e-mails were tracked. The daily number of secure messages ranged from 10 to 20 during the first 4 weeks and progressively diminished over the following weeks when providers were more familiar with the process. The daily e-mails numbered 5-10 initially, followed by a steady decrease. Resources and guidelines were updated in real time within the organization website. Physicians documented the questions and the actions taken so they could be discussed at the daily meeting. Calls were escalated to the infectious disease on-call provider if necessary.

Analysis
The medical community of Grand Rapids, Michigan, like others across the world, was facing uncertainties regarding the novel nature of SARS CoV-2 virus, limited treatment options, shortage of personal protective equipment (PPE), and inadequate testing supplies. 2 Our provider work group played a tremendous role in the psychosocial well-being of the clinicians by aiding with both personal and professional responsibilities and addressing concerns. 2 Providers from intensive care unit, inpatient medical units, ambulatory centers, rehabilitation units, hospice unit, outside hospital, and private pediatric and obstetrics offices reached out to the work group. The spectrum of concerns raised included guidance on testing, PPE, isolation precautions, immunocompromised patients, supply chain, and treatment options ( Table 1).
As we gained more experience with COVID-19 patient care and robust testing and we increased availability of PPE and developed protocols, the number of calls and e-mails steadily decreased, indicating that the clinicians rapidly adapted themselves, mastered new skills, and revised practices. With that decrease, meetings were changed to every other day and then were conducted weekly. The work group was concluded 8 weeks later when the providers were more confident with everyday patient care, appropriate testing criteria, and PPE use for COVID-19 patients.

Discussion
The medical community has come together and responded in a heroic fashion to the challenges posed by the COVID-19 pandemic. 3

Spectrum Health's COVID-19 Provider Resource
Work Group hotline is one of the many efforts instituted to improve COVID-19 patient care and control the spread in both hospital and ambulatory settings. Concerns from the work group were appropriately streamlined to the respective COVID-19 performance committee. Other quality improvement initiatives were conducted based on these concerns to restructure the work flow and to improve patient care. By making the COVID-19 provider hotline accessible to all providers across the community, Spectrum Health prioritized the professional development of healthcare workers as well as their psychosocial well-being during the pandemic.
Frontline healthcare staff are not only experiencing a rapid increase in the volume and intensity of their work but are also facing additional challenges such as unfamiliar working environments, changing protocols, and unprecedented exposure to COVID-19 with little opportunity for orientation and training. 4 It is widely recognized that healthcare professionals need evidence-based support initiatives to mitigate the effects of COVID-19 on their current and future well-being. 4 Spectrum Health's COVID-19 Provider Resource Work Group is an example of a successful and crucial support initiative in closing the knowledge gap and having a positive impact on the providers, emphasizing the need for support resources during these tumultuous times. Similar support initiatives and resources should be made available for clinicians during any other healthcare emergency or outbreak that has a public health impact.