Getting Better All the Time
Peter Van Buren, MD, grew up driving around Burlington on house calls with his father, an internist. “I saw the care and empathy that my dad put towards his patients and it’s what drove me into medicine,” he says.
As a University of Vermont Medical Center cardiologist specializing in heart failure, Dr. Van Buren has developed similarly long-term relationships – some spanning 20 years – with his own patients who travel from all over Vermont and Northern New York to see him at the Cardiology Clinic in South Burlington.
Last March, when the majority of health care services were closed under state-mandated COVID-19 safety measures, Dr. Van Buren felt not just a professional responsibility to make sure his patients’ health care needs were met, but a personal one. That feeling was shared by all of the Cardiology Clinic’s providers, nurses, medical assistants, technicians and administrative staff, says Sheena Barnes, practice supervisor.
“The heart is a vital organ and must go on beating,” Barnes says. “Patients were calling us because they were scared. They knew that cardiovascular disease was an underlying condition that put them at risk. We needed to quickly assess our patient panel and devise a system to make sure no one fell through the cracks.”
A Creative, Coordinated Response
The team’s response to the state’s directive to cease in-person health for all except those who critically needed it was both rapid and coordinated. It ranged from the innovative use of technology to tried-and-true personal phone calls.
Using Epic, the electronic health record, Barnes created a color-coded dotting system clinicians could employ to rank hundreds of patients who had appointments scheduled for everything from checkups to diagnostic tests like echocardiograms. Red meant the patients could be rescheduled, blue meant that a video visit would be appropriate and yellow meant they must come to the clinic for in-person care. “It was using Epic to its full functionality,” says Barnes, who continues to use the dotting system today. “This is a quick and easy system that allows different parts of the department to communicate seamlessly and effectively.”
During the first week, physicians, nurses and schedulers were on the phone constantly, working outside of regular hours, calling patients to discuss their condition, answer questions and reschedule appointments if medically appropriate.
Dr. Van Buren personally called several heart transplant recipients. “They were most at risk for developing serious complications should they become infected with the virus and I wanted them to know they had a lifeline with me,” he says.
Safely Seeing Patients
Kelly Hanley, RN, oversees the clinical staff at the Cardiology Clinic as well as its outpatient non-invasive device clinic; she is also inpatient nurse manager for the noninvasive cardiology department at the hospital. “I've got my arms around the entire care continuum, seeing patients from the beginning of diagnosis all the way to non-invasive inpatient procedures,” she explains.
When COVID-19 hit, “We knew that closing the clinic was not an option for our most acute patients,” Hanley says. The Cardiology Clinic’s Tilley Drive building was designated a non-COVID care site and infection prevention practices put into place continue to protect both patients and staff.
The pandemic also prompted the clinic to quickly partner with IT to begin telehealth visits. By the second week, Dr. Van Buren was seeing a full patient load via video.
“Telemedicine is definitely here to stay. It’s a big improvement from a patient satisfaction standpoint, especially for those with transportation challenges."
- Sheena Barnes
“Telemedicine is definitely here to stay,” says Barnes. About 40 percent of routine visits are now conducted remotely. These visits are appropriate for patients who don’t need diagnostic testing or need to have devices checked. “It’s a big improvement from a patient satisfaction standpoint, especially for those with transportation challenges. Our patients are able to keep up with their cardiology appointments instead of cancelling.”
For nurses like Jonathan Glaude, RN, maintaining close contact with patients has been critical during the past year. “I think one of the biggest thing for us nurses was making sure our patients were OK,” says Glaude. “And that's more than just, ‘Are you OK with your blood pressure? Are your vitals good?’ It’s, ‘What's going on? How are you now?’ We may not [be] able to sit and talk for an hour with each patient, but extending that extra little bit of hope and solidarity and knowing we're all in this confusing time together, I think that that has been a really big thing for our patients.”
Hanley is proud that the team has provided high-quality, safe care during the past year’s many challenges. When the hospital was hit with a cyberattack that resulted in a systems outage, the strengthened bonds, commitment to collaborative care and practice with workarounds helped the team manage the disruption and reassure patients.
Barnes, the practice supervisor, agrees: “I am so proud to work alongside the physicians and the amazing staff members who have pulled together tirelessly for our patients and for each other.”