As the COVID-19 pandemic surged in the United States in the summer of 2021, by mid-August many regions faced soaring COVID-19 hospitalizations, primarily driven by the Delta variant. Oregon was predicted to have a shortage of 400-500 hospital beds by the peak of this surge. When hospitalizations rose, first in southern and eastern regions of the state, OHSU activated the Emergency Operations Center (EOC) to rapidly implement surge plans to address the influx of patients into Oregon’s only academic medical center. Part of this plan included the redeployment of providers into acute care and critical care areas.
It became quickly clear that these redeployed providers needed to be ready to effectively take care of COVID-19 patients from day one and a key element to ensuring their success would be their ability to use the EHR efficiently. This necessitated training them to best use the EHR, within the context of the workflows that they would encounter in the clinical care setting.
Dr. Jeff Gold, former Director of OHSU’s Simulation Center and lead investigator of a research team that has extensively used high-fidelity simulations to investigate EHR use, rapidly galvanized into action with a plan to quickly train outpatient internists for the care of hospitalized patients – a task that some internists have not done for a while. And to achieve this goal, an interdisciplinary team of clinicians, EHR trainers, and clinical informatics fellows were assembled.
“The clinical informatics fellowship at OHSU is a subspecialty of all medical specialties, and since the program was accredited by ACGME in 2014 our fellows have participated in many operational informatics projects at OHSU. But the COVID-19 pandemic has placed some unique stresses on the system, and CI fellows have risen to the challenge to help OHSU fight the pandemic.” said Dr. Vishnu Mohan, program director of the OHSU Clinical Informatics (CI) Fellowship.
The team included CI fellows Dr. Da Jin and Dr. Roheet Kakaday, NLM fellow Dr. Sunil Samuel, senior certified Epic trainers Jane Coffey and Gretchen Scholl, and educational instructional designer Katherine Forney. They quickly developed and delivered training materials in collaboration with OHSU’s Healthcare Epic Applications Training (HEAT) team led by Cassaundra Adams-Murphy. They established learning objectives in partnership with subject matter experts in the Division of Hospital Medicine, developed lesson plans and educational materials for in-person training sessions, and deployed an entirely asynchronous online virtual training program.
Given the success of the acute care training for internists, the Department of Anesthesiology and Perioperative Medicine approached the team with a request to train Certified Registered Nurse Anesthetists (CRNAs) on critical care workflows. OHSU was quickly preparing to convert the Post Anesthesia Care Unit (PACU) into an intensive care unit (ICU) within five days. CRNAs are advanced practice nurse providers who provide anesthesia care to surgical patients, but many of them have had prior experience in the ICU as nurses. Over the next few days, the same team, along with ACGME Clinical Informatics fellow Dr. Chengda Zhang, crafted new learning objectives for this unique cohort of learners, as well as additional lesson plans and educational materials for in-person training sessions and online video modules. The training focused on practical use of EHR in simulated ICU patients, covering efficient information retrieval, user interface customization, and strategies to ensure ICU patient safety. These sessions were then offered daily for a week.
The attendees from these training sessions unanimously rated them as “very” or “extremely” useful. Most attendees report that the training sessions prepared them for new workflows. These sessions continue to be offered through the surge, to support our healthcare staff at OHSU in service of Oregonians across the state.