Table 2.

Recommendations and lessons learned with qualitative data

Themes	Recommendations/Lessons Learned	Provider Feedback on Areas for Improvement*
Training and Orientation	Invest time into orientations, include more training on EHR use with at-the-elbow assistance.	Practice modules for EPIC – orders, admissio ns, discharges, etcetera, as this took a lot of time. I think a video introduction to the system would have been helpful, especially for those of us not in the Department of Medicine, and not familiar with in-patient care. Would also be helpful if their orientation included written material that they can refer to regarding how to discharge, how to discharge to LOH, etcetera. It may already include that, but they vocalized not having it in orientation. I was able to better understand how to use aspects of the Epic that we do not usually use in the ambulatory care center. I learned about the Epic chat features. Became more in touch with my internal medicine which came back from medical school. I’m hands-on, so it’s difficult for me to learn by just following a video. Perhaps an exercise where you have to do a progress note as well as daily orders, new admission orders, and discharge orders. Would suggest a video that would go through the day, what your responsibilities are, and how to handle them. Would outline the Epic tools you need, especially the admission order sets, and charting, as this is what most time was spent on. …more granular[ity] regarding how to transfer a patient and clinical criteria for each of the units, etcetera. Also, clear ways of clinical elevation (how to reach alert team and then ICU), a lot of people coming on are not used to calling consults. Better training – my co-volunteer did not have a good sense of the role of PPE or infection control, and made me very apprehensive about possible spread as that individual was not following the guidelines.
Roles and Teams	Clarify roles and workflow within each team upfront, and clearly identify lines of escalation.	A description of each assignment might be useful. If you were able to group floors and explain what they were, that would help those at home and those not clear what they might be asked to do. Provide more information on roles and responsibilities. We were given minimal information on workflow and expectations. Identify a hospitalist to consult for clinical issues each week. Worked with an outpatient provider who hasn’t been in the [inpatient] environment for years and so it was difficult for her/him/them to do these intern tasks. So, ultimately, I ended up taking more patients, which gave me a 7-patient load. And of course, they all started decompensating around the same time, which was difficult to manage. I think it would be good to emphasize to those who are volunteering that they’ll be functioning as an intern again or at least delineate the responsibilities prior to day 1 of work, because the title of “supplemental attending” can be misleading. I think the coordination of teams would be most important before starting, and I do recognize how challenging that is in the midst of a pandemic! However, I was a primary hospitalist transitioning mostly to non-COVID patients (after reading up on everything for COVID for several days!) and haven’t done inpatient medicine in 10 years. I thought I would have a resident, or at least an NP or PA that knew Epic so I could focus on the medicine….That being said, the support was great to figure out problems in real time and I relayed that in the end. Pair hospitalists with those of us who were hospital naïve. Perhaps circulate some guidelines to care – how often to get inflammatory markers? What to do with anti-coagulation?
Clinical Load	Balance team workload if possible.	Balance acuity between teams, or make the high-acuity services smaller (less patients). My unit was essentially a 17-bed step down unit with every patient on continuous monitoring and many on high flow nasal cannula. One thing to consider is staggering supplemental staff, so everyone is not new at the same time. The person that has been around for a day or two could teach the new team members. Triage volunteered skills/experiences better to allow for redeployment that optimizes volunteers’ abilities, which would make for a more enjoyable experience for the volunteer as well. Patient care was smooth and streamlined – everyone understood their role and there were no issues getting the patients the care they needed, support for discharge when indicated, and keeping communication open with their families.
Guidance	Keep teams updated on evolving policies and recommendations, with focused and clear guidelines.	More support/explanation regarding investigational treatment options for patients. A little more guidance in terms of newest information, but was able to figure it out quickly. Would be very helpful to have a one-page handout or website to refer to regarding the current trials, criteria for using various medications, consideration of anticoagulation. For example, I thought the one-page flowchart of the anticoagulation was supremely helpful… would have been nice to have that readily available on a central site along with other useful information. If such a site exists, would be helpful to include that on the orientation e-mail. The algorithms for COVID care that we were given in our initial e-mails were very helpful, although seemed slightly outdated to what was being practiced on the floors.
Support	Make team members feel valued. Provide clear lines of proactive support from hospitalists and intensivists.	There was variety in amount of oversight/support by hospitalists. I appreciated the hospitalist checking in often. The emotional support and gratitude from all were heartfelt and so gratifying. The patients were also so appreciative for what was being done in these most trying times. The hospital support services are awesome. I’m sure this is something in place at all times but to have the support in this environment was much appreciated. I liked having a team and people above me to turn to. It was nice to feel a part of the overall care group and feel involved with what’s going on. The oneness I felt with all the health care team made the experience quite a remarkable one. I feel the support everyone gave each really did help save the lives of so many people. The tone in the hospital was overall more collaborative and willing to help, especially consulting services which was really nice to see. I felt very valued at every step of the way. They could not have been more welcoming or thankful for my help. It was really great to get to know people from other departments. We all felt like fish out of water a little, and it was really great to support each other and learn together. Also, I felt rewarded to do my part in taking care of patients and fighting this terrible virus. Being there for patients. It was good to have a team focused on communicating with the families – they were wonderful! The tone in the hospital was overall more collaborative and willing to help, especially consulting services which was really nice to see. The actual patient interactions were the most rewarding – I would have loved to spend more time bedside (and less doing the admin charting, etcetera!).
Resources	Ensure they have the right tools available, with an emphasis on must-know information.	We need a handbook with phone numbers and quick how-to’s. A printable “cheat sheet” could have been useful for sign in, med rec, discharge med rec, finding MAR, and a brief dashboard setup to make finding things like labs, etcetera, easier. …Lockers, more scrubs, a cleaner and less crowded physician workspace would have been useful. Wish we did not have to reuse N95 masks, regular surgical masks and head coverings.

Note:

^*All pronouns in the written comments changed to include both masculine and feminine pronouns to ensure confidentiality (respondents used perceived gender in their comments).