“Failure was not an option” during record-long Code D

On March 16, two days after tests confirmed Yale New Haven Hospital’s first COVID-19 patient, hospital leaders declared a Code D (disaster) and activated the Hospital Incident Command Structure (HICS). 

What followed was a whirlwind of focused activities, as YNHH and other Yale New Haven Health System delivery networks overhauled facilities, operations and staffing to provide information, testing and care to thousands. 

Six months later, on Sept. 21, Michael Holmes, senior vice president of Operations and the Hospital Incident Command (HIC) team commander, officially terminated the Code D. It was a major milestone in Yale New Haven Health’s extraordinary response to the COVID-19 crisis.

“People were excited when we terminated the Code D,” said April Alfano, YNHH manager of Disaster Preparedness and Response. “The Hospital Incident Command Structure is typically activated for disasters that last hours to days, such as blizzards, major flooding at the hospital or loss of power. At 190 days, this was the longest period we had been in a declared Code D.”

Holmes decided to terminate the Code D after consulting with Hospital Incident Command Team members at YNHH and other delivery networks, and the YNHHS System Incident Management (SIM) Coordination Center.

“With operations returning to nearly normal, the time was right to terminate the Code D,” Holmes said. “We’re caring for far fewer COVID-19 patients and persons under investigation, and the hospital is well into its transformation phase.”

The availability of resources such as staffing, equipment and patient beds is a major factor in deciding whether to implement or terminate a Code D, Alfano said. Resources also include those from the community, region and state.

To care for the influx of COVID patients this past spring, YNHHS dramatically increased resources, reconfiguring nursing units to make space for COVID patients and acquiring necessary equipment and supplies. To meet staffing needs, YNHHS hospitals retrained physicians and reassigned other clinicians to care for COVID patients. The hospital’s HICS Labor Pool devised a staffing model that allowed hospitals to redeploy employees where they were most needed, and for longer periods. 

The crisis reinforced the value of hospital-based (HICS) and health system (SIM) emergency response structures, components and processes, said Mark Sevilla, RN, YNHH vice president, Behavioral Health and Emergency Services. 

Among the most valuable components were official, regular communications – such as the HICS and SIM COVID-19 email updates. These provided the minimum amount of information people needed to do their jobs in an easy-to-read format, Sevilla said. YNHH’s HICS team learned to release the updates earlier in the week, giving staff time to complete necessary education and training. 

The HICS team also learned to moderate its response to rapidly changing information about COVID. “For example, information about PPE might change three times in three days,” Sevilla said. “Whenever possible, we would try to slow the pace of the changes we were making in response to new information, so we weren’t overwhelming staff.”
 
The HICS team is already working to enhance YNHH’s response to the next disaster – whether it’s a COVID-19 resurgence, influx of influenza patients or weather event. One major enhancement has already occurred – a shift in people’s attitudes, Sevilla said. 

“During COVID, everyone quickly moved into a mindset where failure was not an option,” he said. “Instead of saying, ‘Here’s why we don’t think this will work,’ people said, ‘We’re going to figure out how to make this work.’”