Tales of a department: how the COVID-19 pandemic transformed Detroit's Henry Ford Hospital, Department of Neurology-part I: the surge

Abstract

The COVID-19 pandemic has reshaped the way healthcare systems operate around the world. The major hurdles faced have been availability of personal protective equipment, intensive care unit beds, ventilators, treatments and medical personnel. Detroit, Michigan has been an epidemic 'hotspot' in the USA with Wayne County among the hardest hit counties in the nation. The Department of Neurology at Henry Ford Hospital, in the heart of Detroit, has responded effectively to the pandemic by altering many aspects of its operations. The rapid engagement of the department and enhanced utilisation of teleneurology were two of the pivotal elements in the successful response to the pandemic. In this review, we describe the transformation our department has undergone, as it relates to its infrastructure redesigning, coverage restructuring, redeployment strategies, medical education adaptations and novel research initiatives.

Keywords: health policy & practice.

Figure 1

Plot of COVID-19 total inpatients, ICU patients, and ventilated patients with COVID-19 at Henry Ford Hospital (adapted from the Henry Ford Hospital COVID-19 Dashboard). Prior to the pandemic, most patients in general wards were in semi-private rooms but all beds were converted to private rooms during the pandemic. Note that on 6 April 2020, the peak day for COVID-19 ICU admissions at 140 (with only 14 non-COVID-19 ICU patients that day), the Centers for Medicare and Medicaid Services (CMS)-adjusted Case Mix Index (CMI) was 1.822. The maximum CMI was reached on 4 May 2020 with a value of 3.910 when the majority of the patients with COVID-19 were intubated and/or in ICU beds. ICU, intensive care unit.

Figure 2

Neurophysiology tests performed in the outpatient and inpatient settings at Henry Ford Health System from 6 January 2020 to 8 May 2020. Neurophysiology tests refer to electroencephalography, electromyography, evoked potential and transcranial doppler. 16 March represents the implementation date of the triaging policy for inpatient studies and the postponement of outpatient studies.

Figure 3

Video and telephone visits at Henry Ford Health System neurology department pre-COVID-19 and during the first month of COVID-19 pandemic.

Figure 4

Comparison of outpatient visits for 6 January 2019 to 8 May 2019 and the corresponding epoch in 2020 at Henry Ford Health System neurology department. A 12% decrease in outpatient visits was recorded in the 2020 epoch compared with the same epoch a year ago.