When COVID-19 surged in the spring of 2020, the physicians and staff who work in ambulatory care at Smilow Cancer Hospital and the Smilow Cancer Hospital Network were forced to respond with lightning speed, creating temporary spaces that would allow for social distancing, beefing up technology for relatively novel telehealth visits, and rethinking patient care to keep everyone safe. But the pandemic necessitated deeper changes, too, changes that have reaped some silver linings during the worst of times.
Working together in a whole new way Radical change does not simply happen, even in an emergency situation like a pandemic. To make sure things ran smoothly in the new world of COVID-19, the Smilow campus in New Haven and all of its community locations had to think out of the box and create new processes, “almost from the ground up,” said Anne Chiang, MD, PhD, Associate Professor of Medicine; Chief Integration Officer and Deputy Chief Medical Officer, Smilow Cancer Network. The results will continue to reap rewards on many different levels, including patient and staff safety, convenience, and faster access to care, to name just a few benefits.
“We have tapped about two hundred people throughout the Smilow Network to get involved in Ambulatory Transformation workgroups. They have in turn reached over 700 stakeholders using interviews, focus groups, and surveys to understand everyone’s most compelling needs and to develop best practices across the system,” Dr. Chiang explained. As all the moving parts began to talk to one another, North Haven to New Haven, Torrington to Trumbull, “I’ve had doctors and staff say, ‘Oh, wow, I’ve communicated with this person via email, but now I really know them and how they work.’” Typically, the Smilow Care Centers tended to be separate from one another— or “siloed” as Dr. Chiang puts it—solving problems on their own, in their own way, rather than routinely sharing solutions. “As an example, you’d have a situation in Torrington, say, with insurance pre-authorizations, and the staff in that office might do a little project to figure it out and fix it.” Now, she says, everyone is benefitting from the knowledge each office gleans. “We have a structure where we can think more globally, connecting our network’s best practices, thinking about how one patient’s experience in Torrington can help another patient in Greenwich. “That
process will extend into the future,” said Dr. Chiang. “And that’s really powerful.”
Taking telehealth to another level By now, almost a year into COVID-19, most people have had at least one telehealth visit with a healthcare provider, but in the beginning, Zoom-style interactions were still relatively new. That changed quickly at Smilow: “In April of 2020, in ambulatory care, we were doing 380 remote visits a week,” says Dr. Chiang. “In May, visits shot up to 2500 a week across our network; we’d never used the technology on that scale.”
And the benefits of telehealth go way beyond visits with physicians. “One thing that has emerged from this that’s really important is that we’ve increased patients’ access to care—we can now see them in between their
scheduled visits more easily, or when they’re in hospice, or whenever it’s difficult to travel,” said Dr. Chiang.
Another telehealth advantage that may be especially appreciated by patients who have been newly diagnosed with cancer: Many patients can now get remote access to a provider the very next day after receiving a difficult diagnosis. “We know that getting diagnosed with cancer is very anxiety-provoking,” said Maureen Major Campos, RN, MS, Director of Patient Services at Smilow Cancer Hospital. “Offering next day remote access can really reduce that anxiety. Instead of receiving a diagnosis and jumping on Google right away, then getting even more stressed out, patients and providers can get in touch quickly and talk about next steps. Patients don’t have to sit there paralyzed with fear until their next in-person appointment.”
Another benefit: “We know from studies that at the time of diagnosis, patients are only able to take in about 20 percent of what their doctor is saying, but when they’re brought in another day, they can retain more information,” said Ms. Major Campos.
With telehealth, instead of patients having to absorb an information dump in one fell swoop, they can do follow up sessions at their convenience via videoconference, with a nurse or another provider. “This is going to be a really important platform moving forward,” said Ms. Major Campos.
And while Dr. Chiang and Ms. Major Campos both emphasize that telehealth visits are not meant to replace in-person physician visits, “What’s great about it is that we can reach patients with questions or concerns, quickly address any side effects they might be having, say from chemotherapy treatments, or offer follow-up educational sessions for new patients that they would once have had to travel for,” explained Ms. Major Campos. That could include such services as nutritional counseling, social work sessions, and even getting a patient evaluated for a clinical
trial. “Increasingly, these things will be done remotely,” said Ms. Major Campos. “Patients won’t have to travel all the way here, then find out they’re not eligible for a trial.”
New ways of creating space to keep people safe By now, the term “social distancing” has become part of our everyday lingo—but even after this pandemic passes, the days of crowded medical waiting rooms may be behind us. Necessity is the mother of invention, as Ms. Major Campos puts it, and the ambulatory care team at Smilow has found innovative ways of protecting vulnerable people from potential infection, whether COVID-19 or something else. “I think the pandemic has taught us how important it is to be mindful of patient volume in our clinics, and the close proximity in which we all work,” she said. To tackle pressing space issues, for instance, Smilow put a number of new measures into place, including getting patients in and out of waiting rooms more efficiently by doing pre- visit screenings over the phone instead of in person to avoid bottlenecks. “Instead of patients just showing up, we can
have a plan ahead of time,” explained Ms. Major Campos. Smilow also started making use of its Network locations outside of New Haven to gain more breathing room for ambulatory patients, relocating physicians in specialties that were formerly available only in New Haven, like surgical oncology. “One hundred or so doctors in our Network moved to different locations—surgeons, medical oncologists, and more—and we did it in a seamless way,”
said Dr. Chiang. Because why shouldn’t a patient be able to go to one
location and get nearly all their care in their own backyard, or closer to it? “No one was sure we’d be able to make it happen, but we did,” said Ms. Major Campos. “I wouldn’t want to have to go through it again, but it’s been an amazing journey, and I’m grateful that we endured.”
The truth is, sometimes, it takes a crisis of unimaginable proportions to show everyone—doctors, staff, patients, what we are truly capable of. “It’s been galvanizing, leading to new connections and relationships and more creativity,” said Dr. Chiang. “We are taking advantage of this crisis to transform how we deliver cancer care.”