When COVID-19 cases at Montefiore Health System grew from two to almost 700 in the space of just two weeks in March 2020, those on the front lines of the pandemic knew dramatic changes to regular operations lay ahead. As the reality of the crisis set in, the New York State health department instructed every hospital in the state to double capacity to meet the surge.

 

The Children’s Hospital at Montefiore (CHAM) looked to its inpatient pediatric unit on the building’s eighth floor, and in a short amount of time, transformed it into a 40-bed unit that would become home to a long line of adult COVID-19 patients over the weeks that followed.

 

The last adult patient was discharged from the temporary unit on May 2. “Today, we’re celebrating the discharge of US Veteran, Willie Green, the last patient still hospitalized from our 8th floor adult COVID unit,” Montefiore staff wrote in a tweet the same day. “This children’s hospital unit cared for patients >30 years old for five weeks during #COVID19,” the tweet continued.

 

Approximately 150 adults were treated for COVID-19 at CHAM during the temporary transformation of the hospital’s 8th floor unit. Since the final adult patient was discharged from the hospital on May 2, staff are, once again, caring solely for children. However, if they had been hoping that things would return to some level of normalcy, it was not to be the case. 

 

Norwood News recently reported that in addition to its regular pediatric cases, the hospital is now also treating children who have contracted a recently identified inflammatory syndrome which is potentially linked to COVID-19. The worrisome syndrome has, in recent days, taken the lives of three young New Yorkers, though none of the three died at CHAM. However, as the hospital rises, once more, to meet another COVID-19 challenge, its staff can take comfort in the knowledge that their efforts, to date, are also serving a broader purpose.  

 

In April, a first-of-its-kind report describing the rapid transformation in March of its eighth-floor pediatric unit was published in the Journal of Pediatrics. It’s hoped that the report will provide valuable lessons and best practices for other healthcare providers throughout the country, who may face similar situations in the weeks ahead when dealing with potential COVID-19 surges in their respective states.

 

Kaitlyn Philips, DO, assistant medical director of Pediatric Quality at CHAM is the lead author of the report. “In collaboration with our adult care providers, we quickly trained CHAM clinicians on how to provide an effective, informed and thoughtful approach to care for our new adult patients,” she said. “In a matter of weeks, our physicians and nurses became accustomed to new policies and protocols, caring for adults with a highly contagious disease, and many with other underlying conditions.”

 

In fact, instead of assigning pediatricians to be part of teams led by adult medicine physicians, Montefiore developed a strategy of training pediatrician-led teams and having them work within their own familiar setting. Established CHAM teams of pediatric physicians and nurses consulted with adult-medicine physicians to provide life-saving care to more than 100 patients within ten days of accepting adult patients.

 

The report outlines the steps taken to prepare and train pediatric healthcare providers on how to treat a new, older population, including enhanced communication, adapted rounding practices, and a new coordinated approach with adult hospital medicine providers.

“I’m just very grateful for you all.”
Today we’re celebrating the discharge of US Veteran Willie Green, the last patient still hospitalized from our 8th floor adult COVID unit. This children’s hospital unit cared for patients >30 years old for five weeks during #COVID19. pic.twitter.com/fntDj0FwO2

— Montefiore Pediatrics (@MontefiorePeds) May 2, 2020

 

In addition to providing recommended therapies for adults, the CHAM team recognized that palliative care would be essential. Dr. Michael D. Cabana, M.D., MPH, Physician-in-Chief and Dr. Sarah Norris, director of Pediatric Palliative Care and the Quality in Life Team (QUILT) gathered and trained 27 pediatricians, nurse practitioners and psychologists in just one week.

 

They were then deployed throughout the adult COVID-19 unit at the hospital to help patients and their families stay connected, informed and educated during hospitalization. The expanded QUILT team became a lifeline for patients and their families, available seven days per week to help them as they faced complex medical decisions and uncertainty.

 

“This effort is a true example of interdisciplinary care and all-hands-on-deck preparation,” said Dr. Cabana. “Our teams mobilized early, quickly and effectively to provide high-quality care to the parents and grandparents of their usual patients,” he said. “Being part of a large, integrated healthcare system enabled us to access the expertise and resources necessary to provide this care.”

 

Indeed, Montefiore Health System is comprised of 15 member hospitals and more than 200 outpatient ambulatory care sites that provide coordinated, comprehensive care to patients and their families across the Bronx, Westchester and the Hudson Valley.

 

Similar makeshift arrangements to what took place on the eighth floor of CHAM, were implemented at other hospitals across the state at the height of the pandemic, while health authorities centralized the stockpile of PPE and other essential resources like ventilators between the public and private health care systems, all in an effort to increase efficiency, and manage overflow.

 

Norwood News previously reported on how this temporary and seemingly successful collaboration among healthcare providers may transform the medical landscape in New York State in the long-term.

 

For his part, referring to those who had cared for him during his stay at CHAM, Mr Green said, on the day of his discharge, “I’m just very grateful for you all”.