How the COVID-19, RSV, Influenza "Tripledemic" is Affecting Health Systems, Providers

Gregg Miller, MD, chief medical officer, Vituity, offers his insights on how the combination of COVID-19, respiratory syncytial virus (RSV), and influenza is hitting health systems, as well as what actions can be taken to promote provider wellness at this time.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Dr Gregg Miller shares strategies for combating burnout in health systems amid the ongoing surge of respiratory illnesses.

My name's Gregg Miller. I'm the chief medical officer for Vituity, and I'm an emergency room physician. I practice just north of Seattle.

In my role as chief medical officer for Vituity, I provide oversight around quality and wellness for our clinicians. We have about 3500 clinicians in the acute care space, primarily in emergency departments, including hospitalists, critical care physicians, anesthesiologists, psychiatrists, neurologists, urgent care docs, and a little bit of primary care. We see about 8 million patients across the United States every year.

How do you see the industry handling the current “tripledemic” of COVID-19, flu, and RSV?

I think there's some good news: we have learned in the past couple years from our COVID-19 pandemic experience. Clinically, I think we're better at managing respiratory cases. We're more familiar with certain technologies like high flow nasal cannula, which is something we'd never really used that much prior to COVID-19. Now, everybody's much more comfortable with that, and that's come in incredibly handy during the recent RSV surge we've seen with pediatric bronchiolitis. So, in some ways, we've learned a lot from the COVID-19 pandemic.

We've also learned how to collaborate more effectively, both within and between health systems, when it comes to load leveling patients. Hospitals are able to transfer patients to more appropriate destinations and are able to load level a bit more easily than we have in the past. That's the good news.

I think the bad news is that, in some ways, we are actually much less prepared for the respiratory surge we're dealing with now in 2022 compared to 2019. That's because we've seen this epidemic of short staffing and of burnout. Hospitals are completely overwhelmed right now with a lack of inpatient capacity. The reason for that is multifold, but I think a big issue here is that the postacute space—skilled nursing facilities, adult family homes, assisted living facilities—has dramatically contracted due to short staffing and other challenges, such as financial pressures they're facing.

As a result, patients who need to be in those facilities are remaining in hospitals despite not needing a hospital’s level of care. Hospital beds are taken up by these patients who should be in postacute facilities, which means emergency department beds are taken up by patients who should be in the inpatient unit. It’s just this cascading effect downstream. Ultimately, what that results in is very inefficient care delivery in emergency medicine, and a lot of patients being cared for out of emergency department waiting rooms or in paramedic gurneys or inside of ambulances.

Although we have learned a lot from the COVID-19 pandemic and we have gotten better in a lot of ways, our capacity is dramatically strained right now.

And how would you say the capacity constraints are impacting staff and providers?

Burnout is rampant, and that's been the story throughout the pandemic. Burnout has been increasing year over year, even prior to the pandemic, but there was this very brief moment in the beginning of 2020 where burnout scores actually went down as all these providers turned to face the pandemic.

I think there was this sense of mission. There was a sense of, “this is why I went into medicine, to help my country and my patients face this incredibly overwhelming, brand new public health crisis.” For a moment there, people were somewhat inspired. There was certainly a lot of fear and angst about it, but at the same time, a lot of clinicians leaned into the opportunity to help address this huge public health crisis.

But now, years later, that initial inspiration is gone, and we're faced with short staffing. The people who are showing up to work still are faced with even more challenging situations than they were before because there's less of a workforce to manage even more demand. Burnout has definitely increased year over year in multiple different surveys.

Why is it important for providers to prioritize their wellness?

Physicians, nurses, advanced care practice providers—we're all trained to focus on the wellness of other people, and yet we don't focus on our own wellness first. We have to take care of ourselves first before we're able to take care of patients.

There's plenty of evidence out there showing clinicians who are burned out provide lower quality care to patients than clinicians who aren't. And there is plenty of evidence showing that people who are burned out just quit. If we're not able to take care of ourselves, we're certainly not going to be there to take care of our patients.

This is important for the sake of our patients, and then, more fundamentally, just for ourselves. As health care practitioners, we really do need to prioritize our own wellness for the sake of wellness itself, much less for the sake of taking care of our patients.

What advice would you offer people who are trying to stay resilient on the front lines?

First, you have to take care of yourself physically. Before we ever start talking about mental health, you have to talk about your physical health first. Right now, what that means, especially with this onslaught of the respiratory virus season, is getting your flu and COVID-19 boosters. There is good evidence out there from prior booster experiences, with both flu and COVID-19, that boosters do make a difference, especially when it comes to mortality and hospitalization. These boosters also have a role in preventing infections.

Second, masking. More and more public health officials are calling from masking right now as we're seeing COVID-19 climbing in the United States. Taking care of your physical health by making sure you've gotten your boosters, both for flu and COVID-19, and by masking, is really important.

Beyond that, it's time to start thinking about our mental health. Fortunately, I think this is a national conversation that a lot of people are having, and this isn't quite the taboo subject it once was 5 years ago, to talk about the importance of resiliency and mental health.

I don't think it's right to put the onus on frontline clinicians and to say, "Hey, you've got to take care of burnout yourself." The onus really should be on the system, because it's a broken system that's driving burnout. But, that said, don't hold your breath waiting for the system to fix itself, right? We have to do something right now to manage our own burnout.

Even though it's not fair, the reality is the onus is on frontline clinicians to do something to manage that burnout and resiliency. The data shows getting a wellness coach can help. Learning specific resiliency skills can help. Certainly, I'm not saying that yoga and meditation is the answer to burnout. It's not. The answer to burnout is creating much more efficient systems to deliver care, addressing all the inefficiencies in our practices. But until that happens, we need to make intentional decisions to connect with our loved ones, to take time off, and to really focus on our wellness.

The last thing is, if you're a leader—a medical director of a clinic, a nurse manager—if you are somebody who has leadership opportunities, it is really incumbent on us to lead with wellness in mind and to really focus on the wellness of our workforce. We might not be able to move the boulders that are in the paths of our clinicians, but we can certainly take the pebbles out of their shoes.

We can't change how broken payer contracting or the payment system are in health care, but we can make a difference when somebody shows up to work and the keyboard doesn't work, or when the login process is really complicated, or when a clinician needs a supply, and instead of being right where they need it, they have to go digging for it in a different part of their clinic or emergency department.

As leaders, we can make these small differences that, once combined with multiple other differences, actually add up to a lot. I think it's really important for us as leaders in health care to look for those opportunities to make our practices a little bit more efficient for our frontline clinicians, so they have a better work experience and are able to take care of patients because, ultimately, that's what it's about. We went into medicine to take care of our patients, and we need to be there for our patients as opposed to rummaging around in 3 different drawers looking for tongue depressors. As leaders, we need to make sure that that tongue depressor is right there where it needs to be for that frontline clinician.

Thank you for that insight, Dr Miller. Is there anything else we haven't mentioned yet that you wanted to add?

just want to say thank you to everybody who's out there on the front lines right now. It is a tough time right now. It's been a tough time for the past 3 years. I want to express my gratitude to everybody who's showing up and continuing to make a difference in patient care. It really matters, especially now.

Thanks for tuning in to another episode of PopHealth Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.

This transcript has been edited for clarity.