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Space - utilize areas in the hospital that we were currently not using. Waivers allowed use of space for not normally allowed.

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Regional and corporate call to discuss needs - utilize each other as resources. Could share and help others as needed within system.

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Telemedicine waiver - shift staff from outpatient/surgery to other functions to support COVID.

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Aligned message with all hospitals. Weekly call with all hospitals. Critical at the beginning.

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When hospitals didn't agree to follow aligned message it was a problem. One hospital would always go "rogue"

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ESF-8 coordination.  Weekly calls, locally and across the state.
Challenge - people would make commitments and not follow through.  People who make those statements must have the authority.

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Capacity to take on everything that was needed.

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Dedication to make efforts to pivot to make things work.

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Testing supplies and testing results coming back quickly. Didn't feel like they had a lot of support outside of system. Caused a lot of delays. Used more PPE than was necessary due to this.

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Supplies - PPE, using garbage bags as gowns. Supplied through corporate office

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Entered into huge contracts for PPE and now have overages or not the correct PPE that it's been a challenge to keep consistent. Was not easy to get state supply, so bought ridiculous things.

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Did have respiratory support from MACC/MSST that was helpful

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Management and utilization of PAPRs and supplies.

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Trying to find placement for patients in skilled facilities.

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Confusing in the beginning.  Documentation was difficult because the available forms did not really fit the situation.  Requirement to complete form changed as the pandemic progressed. Did not feel like they got a lot of support in the beginning, then some things came available and distribution of some supplies was a benefit.

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Case managers valley wide were willing to share data with MSST in order to get patients moved and have situational awareness. Helped her try to help them.

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Few times there were some difficulties getting death certificates. Some of the smaller facilities had difficulties, waiting longer sometimes for pick up. Not much of a problem.

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Would get a call about reaching capacity, never reached point, but already had facilities set up for it even though they were never needed.

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Plans in place for fatality management.

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Regular communication with the team with a set agenda: labor, resources, facilities, etc. Everyone made the time to commit to it and were able to coordinate better across the system.

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Clinical - critical care adopted best practices from east coast. First to delay intubation, prone patient, use high-flow more. Spearheaded COVID critical care protocol.

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Surge plan - surge for every level of care. Ten-layer plan for surge. Implemented aspects throughout the pandemic. Worked well for recent surge.

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Misinformation was detrimental to everything we did.

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Had to put out information that is not normally put out - not a testing facility: what is urgent care/primary care/etc.

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Home O2 paperwork and testing and specific company - took time. Did not have a lot of capability to discharge people from the ER to Home O2 so had to admit them.

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Pathway to follow for length of stay for COVID that is similar for pneumonia. Different physicians were not following same procedure for treatment.

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SNF/LTAC - policy or protocol to deal with patient placement after hospital care.

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Staffing!!! Last wave - more staff got sick. Continue to see shortages. Staff turnover. Would be in trouble if patient levels got back to January 2022 level.

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PTSD - impact staffing. Lack of resources for healthcare workers in general. Compassion fatigue, burnout.

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mental health patients skyrocketed during shut down, especially pediatric. Tapering off now as things normalize. Overall behavioral health issues have been a problem which are leading to PTSD.

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SNF capacity - suffered financially because they were providing care at an acute care level when patients could have been at a sub-acute level. Two entire units' worth of patients at one time were in acute care when not needed.