In a state with a famously competitive health care market, the unrelenting coronavirus pandemic has compelled hospitals to do something they’ve never had to do at this scale: work together to get through a crisis that threatened to overwhelm them.
The collaboration is largely about managing the flow of patients, but it also includes sharing advice about treatments and vaccinations.
“During this time when resources can be very scarce and you have to do multiple things at once, without the collaboration among hospitals and among providers and among staff, you cannot fire on all cylinders,” said Dr. Dani Hackner, chief clinical officer at Southcoast Health, which runs hospitals in New Bedford and Fall River.
As COVID-19 spread swiftly after the holidays, hospitals in Southeastern Massachusetts were running out of space. So officials at Southcoast got on the phone with leaders from rival institutions and asked for help.
The urgent appeal was answered, and Southcoast has transferred two to five patients daily to other hospitals during this taxing period.
Discussions among hospital leaders began informally last year when COVID emerged in Massachusetts, and it has become routine during the wave of cases this winter, with almost daily calls among CEOs and other hospital leaders.
The competition for patients, revenue, and prestige will almost certainly return. But for now, it is mostly on hold.
“What we’re trying to do as a state, and I think pretty effectively, is for the purposes of the pandemic almost behave as a single system,” said Dr. Kevin Tabb, chief executive of Beth Israel Lahey Health. “In the first wave, sometimes what that meant was transferring of equipment, like ventilators from one hospital system to another. . . . What we need now is the ability to transfer patients.”
The goal of the cooperation — which is occurring with guidance from the state — is to prevent any one hospital from being completely overburdened while another has beds and staff to spare.
Hospital chiefs talk most frequently with others in their region. Twice a week, CEOs from across Massachusetts join a call with Governor Charlie Baker and Secretary of Health and Human Services Marylou Sudders. They also strategize on frequent calls led by the Massachusetts Health & Hospital Association. Other informal conversations happen all the time.
“They have an opportunity to talk about treatment, and number of beds, and what’s working and what isn’t working, and capacity challenges in the emergency department, and discharges out of the facility,” said Steve Walsh, chief executive of the hospital association. “The level and spirit of collaboration is really something that has never been seen before.”
The conversations go something like this: I’m running low in the ICU. Can anyone take a few ICU patients? My medical floors are full. Does anyone have excess capacity? What’s happening in the Worcester field hospital? Can we transfer patients there?
The number of patients hospitalized for COVID in Massachusetts grew steadily from the end of summer through the beginning of January, infections accelerating as people gathered indoors over Thanksgiving and Christmas. Hospitalizations reached a peak of 2,428 on Jan. 4, stabilizing and falling gradually since then.
The number of people hospitalized for COVID now is less than half the number last April.
Hospitals largely stopped their regular work and focused almost entirely on COVID at the start of the pandemic. Now, they have cut back on scheduled surgeries, but mostly they are trying to take care of patients with COVID — as well as patients with other urgent medical issues. Many hospitals are busier now than they were last spring.
Boston Medical Center is treating twice as many non-COVID patients as it was during the first surge.
“We are absolutely in surge mode, but it’s a combination of COVID and non-COVID care that’s driving that,” said Dr. Alastair Bell, BMC’s chief operating officer.
The high demand on hospitals from non-COVID patients is somewhat reassuring. Last year doctors worried that people were so afraid of COVID that they were avoiding hospitals even for serious issues such as heart attacks and strokes. That concern has dissipated.
“People are still seeking care appropriately,” Bell said, “but it does place demands on the operation.”
This winter, BMC has transferred as many as four COVID patients a day more than 40 miles away to the field hospital at the DCU Center in Worcester. So has Southcoast, a community hospital system that has been particularly challenged, peaking at more than 150 COVID patients in early January.
As others have done, Southcoast converted available space into COVID units, even adding portable rooms with negative air pressure designed to prevent the spread of infection. But that hasn’t been enough. To weather the surge, Southcoast transferred patients to the big Boston teaching hospitals, and to Cape Cod, Brockton, and Plymouth, among other places.
“Every patient counts when you see a spike and you’re limited in your capacity,” said Hackner, the chief clinical officer.
Other hospitals, meanwhile, are not seeing as many COVID patients as once feared, so they’re in a position to help. Christine Schuster, chief executive of Emerson Hospital in Concord, said she regularly accepts patients from competing hospitals in Newton, Clinton, Salem, and other communities.
“Every day we look at our census and we say ‘Can we accept transfers, yes or no?’ ” Schuster said. “We sort of put the word out that we could take five more patients or four more patients.”
“This is a time when everyone is trying to be collaborative and cooperative,” she said. “There isn’t a lot of time to debate.”