Treating Our Patients Like Family: Developing Resources and Infrastructure to Promote Equity

This article is part of a series in The Hospital Leader written by members of the Division of Hospital Medicine at Dell Medical School at The University of Texas in Austin, exploring lessons learned from the coronavirus pandemic and outlining an approach for creating COVID-19 Centers of Excellence.

“¡Por favor sálvenlo!” “Please, save him.” The woman’s voice sounded like my Spanish-speaking mother. I watched her struggle with the language barrier, trying to understand what the medical staff were saying and navigating the complexities of our healthcare system under the strain of a pandemic. Meanwhile, her dear loved one was deteriorating before her tear-filled eyes, and she could only talk with him via phone. This is a scene that we have witnessed too many times during this pandemic.

In our local community, Latinx workers in unprotected frontline industries and their families, have borne the disproportionate brunt of COVID-19. Of the first ten patients admitted to our hospital with COVID-19, nine identified as Latinx, all of whom spoke Spanish as their primary language, and six of whom were in vulnerable jobs without adequate PPE, including construction work and food services. Thinking back to the start of the pandemic, no one knew the grim reality we would face caring for patients hospitalized from COVID-19. But we did know that healthcare systems can perpetuate structural inequities and can further marginalize minority communities and those who speak a language other than English. Hospitalist leaders in the areas of health disparities and equity immediately mobilized a multidisciplinary team made up of case managers, social workers, internal medicine residents, infectious disease physicians, nurse champions, medical students, and faculty. Within a week of admitting our first patients with COVID-19, we held virtual strategy sessions and created lists of priorities that we needed to address.

Our overarching goal was clear: to create a patient-centered model of care even in the face of a pandemic that posed serious barriers to family visitation, trust, and care. Using process mapping, we identified key steps in the hospitalization and discharge process that needed restructuring. We emphasized the need for language-concordant care to counsel patients and families effectively and build trust. We created protocols for contact tracing and prioritized developing a process for performing health-related social needs assessments and connecting patients with resources to address unmet needs. We also created a streamlined pathway for primary care follow-up for patients without medical homes. With a sense of urgency, we created a set of resources to support our patients during this time of economic hardship, resources that would be essential to help our patients and families isolate and quarantine after testing COVID positive, resources that would enable public health strategy to be effective. We developed a checklist to ensure that all necessary processes were completed prior to patient discharge.

After multiple iterations of discharge scripts and family communication tools, we were able to streamline our toolset and effectively counseled numerous patients and families thereafter. Our initial numbers indicated that most of our patients were Latinx patients with some form of income, housing, or food insecurity. A total of 80% of patients who had a formal health-related social needs assessment completed were connected with resources to begin to address their immediate needs prior to discharge. Language concordant counseling occurred with 97% of the patients’ family members. More than 90% of patients without a previous primary care physician were seen (often virtually) by a provider within one week of discharge, which is significantly higher than our standard numbers. Our early achievements meant more to us than simply having successful PDSA cycles and favorable data results.

In building these processes and strategies, we were creating tools for our own family members who speak a language other than English. Tools that we would hope our own families would have access to if they were to get ill. Strategies to build trust with our patients and their communities. Working in healthcare exposes just how complex the system is and how difficult it is to navigate. Changing our perspective to see our patients as our own family and community members allowed us to view the importance of addressing our patients holistically.

One of the very first steps to creating a COVID-19 Center of Excellence entails creating a system that prioritizes the counseling process in a language-concordant manner, empowering the patient to care for themselves and their community. Previously, medical teams coordinated medical plans and follow up on discharge, but our efforts have allowed us to explore options beyond the standard of care and to address unmet social needs that significantly influence our patients’ healing once they return home. Our efforts to wholly center our patients during this pandemic have laid the groundwork for us to refocus our model of care for other patients admitted to the hospital for myriad diagnoses.

Many of our patients face historic and contemporary structural disadvantages, and the COVID-19 pandemic has exacerbated inequities among many communities of color. A COVID-19 Center of Excellence must step up to the challenge of promoting equity through systems re-design – prioritizing those most affected by developing resources to support the medical and social needs of our patients, their families, and our communities.