Table 1.

Selected COVID 2.0 Playbook Challenges, Innovations, and Future Preparedness Plans

Challenges	Innovations	Preparedness plans
Clinical Disease Management
Community MDs uncertain about referrals for admission, testing, treatment	MD education via live, internet‐based webinars; Command Center internet information; e‐mail blasts; chairpersonʼs virtual meetings	Develop process for earlier preparation and command center activation based on analysis of admission rates and percentage positivity; earlier communication
Clinical treatment uncertainty	HMH Clinical Guidelines interdisciplinary team development; dissemination	Expand rounding in clinical locations
	HMH School of Medicine students review and summarize new research for clinicians	Develop standing literature search functionality to inform guidelines and practice
	Expand clinical guidelines	coaching program for infection prevention best practices
Clinical site inexperience	Partner new and experienced nurses and physicians	Improving online COVID‐19 resource center for team members
Delays in discharge due to family and post‐acute care infection concerns	Discharge NP to assist complex family, post‐acute care issues	Simplify processes
Patients with hypoxia	Proning Service; clinical guidance on management
Unusual pressure injury from proning	Additional clinical guidance on proning, pressure injury prevention	Conduct prediction models for local second COVID‐19 and influenza surge
Complexity of admissions for redeployed physicians	Hospitalist admission workup for all COVID‐19 patients; then assignment to ward teams
Complex medical decision‐making and methods of family communication	iPad use, family communication teams, increased patient visibility
Infection prevention	Multidisciplinary workgroup review and response for team members, patients, family	Update protocols
Delirium	Increase patient visibility, case review, geriatrics consultation	Add training and guideline section for delirium protocols
Ethics
Concern about allocation of resources	Rapidly developed HMH policy and infrastructure to adapt and implement state policy for Allocation of Critical Care Resources During a Public Health Emergency	Strengthen ethics education and training regarding clinical decision‐making
	Partnered with Learning and Development to extend bioethics education to ensure fair allocation of resources
	Ensure that relevant policies are collaboratively developed provide COVID‐19–relevant bioethics
Issues regarding advance directives	Temporary addendum Do Not Attempt Resuscitation policy to meet the unique demands of the pandemic.
	Adapt procedures for Do Not Attempt Resuscitation orders to meet the challenges of the pandemic
Staff and physician anxiety, illness	Departmental support, institutional webinars, website information	Partner with Wellness to expand opportunities for moral distress debriefs for frontline providers
Research ethics: projects and enrollment	Bioethics participation in research committee to support, guide, and collaborate in COVID‐19–related research protocol development	Incorporate learning in larger research ethics framework
Personal Protective Equipment
Variability in PPE use	Infection prevention team assessment of PPE effectiveness	Standing guidance, reassessments with types of infections (influenza, COVID‐19)
	Clinical Disease Management standardize protocols across settings, institutions, incorporate CDC guidance	Stockpile critical PPE and supplies; enhance PPE education, oversight, and enforcement processes
	Staff/MD education by webinars, video, in‐person PPE training hourly	Standardizing local oversight of PPE distribution, management, and procurement
	Network procurement, monitoring, distribution	Create a new Value Analysis Rapid Response Team to evaluate new sources of PPE

Abbreviations: HMH, Hackensack Meridian Health; MD, doctor of medicine; NP, nurse practitioner; PPE, personal protective equipment.