Sometimes it feels like the COVID-19 pandemic is a very long horror movie. But despite the grimness and mounting death tolls, it has unlocked some positive changes, such as new public health strategies, new safety protocols, and new staffing practices.
That last involves us of course – and so does a new report from Office of Inspector General, which assessed Indian Health Service (IHS) and Tribal hospitals that use Critical Care Response Team deployments. The report analyzed CCRT deployments and issued recommendations to leverage the program’s value across other facilities.
The Need for CCRT Deployments
We’ve spoken before about our CCRT program and the rapid increase in demand during the pandemic. Our teams visit Tribal and IHS facilities to provide hands-on training, along with reference guides, protocols, care checklists, and mock drills. Facility staff learn how to perform intubations, administer COVID-19 medications, assess and treat hypoxia, manage patients on ventilators, administer Monoclonal Antibody Therapies, and more. These brief deployments create long-term change, with freshly trained staff able to practice new care delivery methods, keep patients close to home, and foster trust in their communities.
They’ve also played a life-changing role for many Native American communities. If COVID-19 was tough on the U.S. hospital system, it has been brutal for understaffed, resource-challenged IHS and Tribal facilities. Staffing shortages are epic – and SARS-CoV2 hit Tribal nations hard, with the CDC reporting Native American hospitalization rates 3.5 times as high and death rates 2.4 times as high than for white people. For younger Native Americans aged 20-49 years, death rates are estimated to be 8 to 12 times higher than for white Americans. If that sounds shocking, consider that the real numbers for morbidity and mortality rates are likely higher, due to common racial and ethnic misclassifications.
It’s easy to see why IHS launched the CCRT program in May 2020. The result, according to the OIG report: “In interviews, IHS officials and staff credited the CCRT training with saving lives and stated that the teams’ presence boosted staff’s confidence and skills.”
How CCRT Deployments Work
Tribal Health CCRT teams typically consist of a critical care physician, one or two critical care nurses, and a respiratory therapist, all deployed in 24-48 hours thanks to expedited credentialing, privileging, and onboarding. These deployments typically last 2 weeks, with close oversight and frequent communication between us, facility and IHS headquarters.
Here’s what the team does:
- Assess facilities in terms of logistics, policies, procedures, equipment and supplies – from emergency codes to infection control.
- Provide elbow-to-elbow training to build staff skills at treating critically ill and COVID-19 patients.
- Provide direct patient care, particularly during patient surges.
Clinical Training and Expert Care
Per the report, CCRT training covers a wide range of topics, including using PPE, ventilation and airway management, Vapotherm therapy, other high-flow nasal oxygen therapy use, and “proning” — turning a patient from lying on their back to lying face down to reduce respiratory distress. The report noted the training is mostly interactive, with mock drills and lectures, and not in a hospital conference room with a lecturer up front. Furthermore, some training happens during direct patient care.
The benefits to this approach? Instead of sending a few staff offsite at a time to a training clinic, all staff get trained at once without missing their shifts. That includes staff from multiple departments, so any clinician pulled in during a surge knows what to do.
“In interviews, a number of IHS officials and facility administrators noted that the training and the onsite presence of the CCRTs were crucial to instill skills and confidence in staff who often felt unprepared to manage COVID-19 patients,” the report noted. “Several IHS officials and staff credited the CCRT training for saving lives because without it, the facilities would not have had the knowledge or skillset needed to adequately care for COVID-19 patients.”
Building a Future of Clinical Excellence
Our CCRT teams also make recommendations for facility improvements, like replacing outdated equipment, installing divider walls between patient beds, and obtaining better ventilation systems and additional oxygen supply. They also help revise policies and procedures, such as new discharge and follow-up protocols or establishing a transfer agreement between an urgent care clinic and an IHS hospital. Finally, they designate “super trainers” who carry on their work after they leave.
The OIG report noted these recommendations and made a few of their own. They found the CCRT deployment model could be valuable beyond critical care and recommended facilities leverage it for broader care improvement efforts. That could include asking the CCRT for more improvement changes for the rest of facility, sharing their recommendations across all Tribal and IHS facilities, and using training deployments for other clinical disciplines – all of which we agree with.
Creating a Legacy of Quality Care
Please consider checking out the report for yourself. Its findings and recommendations go beyond critical care and explore the much larger scope of quality improvements so important to Indigenous healthcare. We’re excited to see such high-level players helping to shape the future at IHS and Tribal facilities – and we’re already working on similar programs in other areas.