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Coordination and Collaboration Across a Health System: Chester County Hospital Shows How Waves of COVID-19 Promote Learning


The COVID-19 outbreak in the United States has hit in localized waves, first hitting the northeast, especially New York City and northern and central New Jersey, before fanning out across the country, just as now cases are spiking in the South and West as they’ve flattened out in the Northeast.

That pattern meant that by the time the first cases of the novel coronavirus were diagnosed in the greater Philadelphia region in March, some hospitals in New Jersey were already nearing capacity. Penn Medicine Princeton Medical Center (PMC) was among them.

“They (PMC) were essentially the first front of this response,” says Kevin Sowti, MD, MBA, chief of staff at Chester County Hospital, who answered PMC’s call for backup from another Penn Medicine hospital.

As each of Penn Medicine’s hospitals began to feel the brunt of the outbreak at different times earlier this spring, they relied even more on their close-knit network to shore up resources, staffing, and safety protocols, underlining the importance of coordination and collaboration in a crisis. One of the first bright examples of that process was Sowti and others at Chester County offering support to PMC.

While Chester County Hospital’s leadership organized its COVID-19 response strategy, Sowti, who is also medical director of the Hospitalists and section chief of Hospital Medicine, was in frequent contact with his counterparts at PMC offering whatever support they needed to meet the high volume of COVID-19 patients they were seeing.

These calls between PMC, Chester County, and the other four Penn Medicine hospitals started with the onset of the pandemic as a means of sharing preparation strategies and best practices. As the crisis escalated, however, the conversations became a means of monitoring one another’s COVID-19 patient intake and ensuring that each organization had the resources it needed, from personal protective equipment (PPE) and ventilators to staff.

For its part, Chester County Hospital provided 11 ventilators to PMC, and Sowti was prepared to organize a team of physicians from the hospital to help. But shifts and responsibilities were already being realigned at Chester County Hospital, making it a challenge for staff members to break away from their work there.

Kevin Sowti, MD, MBA

He managed to carve out some time and worked two night shifts at PMC over a weekend early on in the outbreak. The experience, he says, was meant to inform his own hospital’s preparations as much it was to help care for the influx of COVID-19 patients.

“I wanted to see how resources were being allocated across Penn Medicine and how the credentialing of new medical staff would work since we needed to incorporate an expedited process for bringing additional physicians onboard at Chester County as well,” Sowti says.

In anticipation of their own surge, the team that designed Chester County Hospital’s COVID-19 response plan enlisted the help of retired physicians and specialists who ordinarily work at other facilities. All were licensed physicians, and their backgrounds were verified by the hospital, but they were not formally credentialed. Fortunately, in light of the urgency of the circumstances, the state had temporarily suspended the credentialing requirement.

By the time Sowti returned to Chester County Hospital, its COVID-19 plan was in motion, under the supervision of Karen Pinsky, MD, chief medical officer. Two floors of a newly completed but not-yet-opened patient tower, constructed as part of the largest expansion in the hospital’s history, were quickly outfitted and dedicated to treating COVID-19 patients. A third floor was prepared as an intensive care unit (ICU), reserved for COVID-19 patients. A number of nurses and physicians cross-trained so that they could be reassigned to the new units. And those who were familiar with the settings were put into supervisory roles.

“It’s been really invigorating for me to see so many of my colleagues — not just the hospitalists I work with day in and day out but specialists and even retired physicians — step up to this challenge without any hesitation,” Sowti says. “The degree of collaboration and empathy across all kinds of caregivers has been amazing.”

Sowti and the others who staffed the COVID unit faced a number of challenges once patients started flowing in: nurses and doctors acting as liaisons between isolated patients and their families, the constant donning and doffing of PPE, and even feelings of helplessness. But the hospital never quite experienced the large surge in patients they had prepared for. “We’ve been fortunate in that our response strategy was designed for a worst-case scenario, and that day, so far, hasn’t come. Between shoring up our own hospital and the added security of the system-wide monitoring, we’ve had enough PPE. We’ve even shared some with other Penn Medicine hospitals,” Sowti says. “And we’ve been in a position to accept patients from some harder-hit areas.”

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