The Nashville Healthcare Council recently featured Vanderbilt University Medical Center Deputy CEO and Chief Health System Officer Dr. Wright Pinson in the latest installment of "Health Care Brass Tacks." This virtual series invites Council board members and C-suite health care leaders to discuss their unique perspectives on the coronavirus pandemic and its overall impact on the health care industry. Pinson spoke with Council President Hayley Hovious about the nationwide increase in COVID-19 cases, potential treatments, vaccine trials, and his outlook for the coming months.
Vanderbilt University Medical Center is one of the largest academic medical centers in the Southeast, managing more than 2.3 million patient visits each year. VUMC's graduate medical education programs train approximately 1,000 residents and fellows in more than 100 specialty areas. Through the Vanderbilt Health Affiliated Network, VUMC works with more than 60 hospitals and 6,000 clinicians across Tennessee and five neighboring states to share best practices and bring value-driven and cost-effective health care to the Mid-South.
In addition to providing medical care and educating future generations of doctors and nurses, VUMC has an active role in COVID-19 treatment. "What is different about an academic medical center is that, while care delivery is an important aspect of our mission, research and educational enterprises are also big missions," Pinson said. VUMC is currently involved in numerous COVID-19 clinical trials involving drugs such as, remdesivir, lopinavir, ritonavir, razuprotafib and even nicotine. The organization is also exploring new treatment methods, such as pragmatic positioning for patients in respiratory distress and nasal saline irrigation using baby shampoo.
More than 200 groups around the globe are working on potential vaccines, and VUMC has been involved with more than one, including the Moderna vaccine trial. Moderna has successfully passed Phase I trials and is now enrolling participants in Phase II and Phase III trials, which test the safety and efficacy of the vaccine. Pinson is hopeful we will see a vaccine this year but cautioned the audience not to be overly optimistic. "It can take decades to identify a vaccine. We've put a lot of work into this one but need to be realistic that we might have something within months or a decade." On the bright side, he said, "there is no question" health care providers are treating COVID-19 patients more successfully than they were just months ago when COVID-19 arrived.
While Pinson said Middle Tennessee's spike in cases appears to be leveling out with more people wearing masks and physically distancing, the number of VUMC's hospitalized patients has doubled since March and encompasses a broader age range. Clinical teams report patients appear more sick than earlier COVID-19 cases. Pinson said an issue for VUMC and neighboring health systems is the shortage of nursing staff. Approximately five hundred out of 26,000 VUMC employees have tested positive so far and were required to stay home for 14-day quarantine periods. While more than half have been able to return to work, at one point about 200 were out.
"Most hospitals in Nashville are pretty full," said Pinson. "Things were tight before this week, but now more so. When I think about where this could go, over the next three months we might see double the hospitalizations. I believe health care systems will manage it, but it will be a strain."
Looking ahead toward the fall and flu season, Pinson believes the pressure on health care providers will worsen and said VUMC is taking multiple steps to get ahead. The organization has hired 450 new nurses since the start of the pandemic and is still actively recruiting nurses and nursing residents. They also have a plan for their care teams, appointing experienced nurses and physicians to lead groups of less experienced clinical staff to teach them about COVID disease management and how to make expert COVID care "go further." VUMC also launched a COVID Hospital at Home program and a telehealth system manned by nurse practitioners and medical students who follow up on COVID-19 patients who do not require hospitalization.
Additionally, VUMC has a thoughtful plan in place should hospitals be required to once again close departments or postpone scheduled procedures. "When we "reopened", there was a remarkable pent-up demand for health care. For example, we admitted 200 more patients per month out of the ER than we normally do because people were putting off care, and when they finally came in, they were sick enough to require hospitalization," Pinson said. "Ramping down broadly what was termed 'elective work' might not have been a good idea. This created what is called the 'other health care crisis.' Stopping care for other health needs for COVID-19 patients is not the right thing to do. This time around, we've developed a much more refined list to cut back on if we need to. The approach of broadly pushing off care will not be a key part of what gets us through the next several months."
Alongside the COVID-19 pandemic, the United States is addressing systemic racism and has issued a call for equity and inclusion. The health care industry is not immune to racism and bias. Pinson said the pandemic is making health care disparities even more obvious, and data indicates certain racial groups are more highly impacted by COVID-19 and lack access to treatment. VUMC has created a task force to deliver anti-racist training to senior leaders and board members and examine policies and practices for inherent bias.
"All of us, no matter our role or organization, need to take a long, hard, honest look at ourselves and our behaviors," said Pinson. "At the root of all of this is the notion of unfairness. We have all experienced a time when we were treated unfairly, and that emotion digs pretty deep. If you are treated unfairly on a systemic basis, by race, gender, or anything else if it is much worse. Equity is a transcendent value we need to achieve."