Methods

The COVID-19 Provider Resource Work Group and hotline were commissioned on March 19, 2020. The aims of the work group were (1) to provide real-time provider-to-provider education regarding questions that pertain to COVID-19; (2) to respond to a COVID-19 e-mail inbox that received questions from 31,000 employees within the Spectrum Health System; (3) to enable triage providers to direct their patients to appropriate channels; and (4) to improve provider access to updates on testing, treatment guidelines, and web-based resources. In total, 18 Spectrum Health physicians from infectious disease, allergy and immunology, internal medicine, and pulmonary critical care, as well as infectious disease fellow physicians volunteered to be part of the work group.

Initially, clinical questions from all the providers across the medical community would go through the provider hotline. This hotline was attended by a nurse who directed the appropriate calls to the on-call physician from the work group. Physicians self-assigned themselves to 4-hour shifts 7 days a week from 8 a.m. to 9 p.m. on a secure HIPAA-compliant communication platform called Perfect Serve. A shared inbox “covid19dr” was attached to the physicians’ personal organization e-mail to receive questions. After an initial meeting that was organized to review the goals and objectives, the work group communicated daily to discuss the challenges, work flow, and current literature. Physicians self-educated on the current literature by reviewing Spectrum Health LitCovid, an internally created database maintained by the research department. No additional financial incentive was provided to the physicians; participation was voluntary.

The calls and e-mails were tracked. The daily number of secure messages ranged from 10 to 20 during the first 4 weeks and progressively diminished over the following weeks when providers were more familiar with the process. The daily e-mails numbered 5–10 initially, followed by a steady decrease. Resources and guidelines were updated in real time within the organization website. Physicians documented the questions and the actions taken so they could be discussed at the daily meeting. Calls were escalated to the infectious disease on-call provider if necessary.

Analysis

The medical community of Grand Rapids, Michigan, like others across the world, was facing uncertainties regarding the novel nature of SARS CoV-2 virus, limited treatment options, shortage of personal protective equipment (PPE), and inadequate testing supplies.^{Reference Pfefferbaum and North2} Our provider work group played a tremendous role in the psychosocial well-being of the clinicians by aiding with both personal and professional responsibilities and addressing concerns.^{Reference Pfefferbaum and North2}

Providers from intensive care unit, inpatient medical units, ambulatory centers, rehabilitation units, hospice unit, outside hospital, and private pediatric and obstetrics offices reached out to the work group. The spectrum of concerns raised included guidance on testing, PPE, isolation precautions, immunocompromised patients, supply chain, and treatment options (Table 1).

Table 1. Spectrum of Calls and E-mails Received by the Provider Resource Work Group

Note. PPE, personal protective equipment; CPAP, continuous positive airway pressure.

As we gained more experience with COVID-19 patient care and robust testing and we increased availability of PPE and developed protocols, the number of calls and e-mails steadily decreased, indicating that the clinicians rapidly adapted themselves, mastered new skills, and revised practices. With that decrease, meetings were changed to every other day and then were conducted weekly. The work group was concluded 8 weeks later when the providers were more confident with everyday patient care, appropriate testing criteria, and PPE use for COVID-19 patients.