Based on an American Medical Association news article published April 28, 2020 and Sara Berg’s interview with Bryant Adibe, MD, Chief Wellness Officer, Rush University Medical Center, Vice President, Rush University System for Health, Chicago, IL.
Learn how Rush University Medical Center (Rush) commissioned a special Wellness Task Force to create tactics to reinforce well-being during the COVID-19 pandemic.
“We know outside of a pandemic, health care workers are already at a high degree of risk for burnout and other issues around their well-being,” said Bryant Adibe, MD. “We recognized it was really a priority to make sure that the well-being and mental health of our frontline workers was getting prioritized and ensuring that we had an organizational infrastructure in place to not just get through this crisis, but to ultimately allow our community to thrive.”
Developing the Intervention
Early into the evolving response to the COVID-19 pandemic, Dr Adibe commissioned a special Wellness Task Force. This task force was devoted to coordinating Rush University Medical Center's efforts as part of the overarching command center structure. With its collective expertise, the task force created 5 key mitigation tactics to reinforce well-being throughout the crisis.
The interventions were implemented in addition to an existing, comprehensive wellness initiative already in place at Rush. However, a primary outcome of the task force was the creation of an advanced, interdisciplinary Wellness Response Team composed of about 25 experts, including psychiatrists, psychologists, advanced practice providers, nurses, and chaplains who serve as the primary workforce supporting the COVID-19 response efforts.
“Part of the innovation and what we're trying to do is to take our well-being initiatives and make them proactive versus reactive … [It is important to] get out and connect with people instead of waiting or expecting them to reach out in the first place.”
—Bryant Adibe, MD
Here are the 5 key resources that were created to manage mental health and enhance well-being for physicians and other health professionals at Rush during the COVID-19 pandemic:
1. Wellness rounds
During a time with heightened levels of anxiety and concern, the consistency and formal structure of Rush's wellness rounds empowers the group to address immediate issues through a real-time feedback loop.
“It's really inspiring to see this group come together with the sole mission of taking care of the caretakers and making sure that our community is well addressed,” said Dr Adibe.
Members of the Wellness Response Team were divided into unit-specific teams to target different areas of the medical center with the heaviest COVID-19 clinical burden. These areas included the emergency department, existing medical and cardiac intensive care units, and novel ICU floors that were launched in response to the pandemic.
Each weekday at 2:30 PM the Rush Wellness Response Team meets for a huddle to discuss the state of their assigned units. When the huddle breaks, the team rounds on their assigned units. A night team also covers all floors on the wellness census 3 times a week from 10 PM to midnight.
For example, during one of the wellness rounds, the team was able to help a doctor who tragically lost a parent to COVID-19 overseas.
“They interacted with this person who outwardly was great but as they prodded and began to ask how they were doing, they opened up and really expressed their concerns about this recent tragic loss of their parent, and the fact that they were now treating these very same patients; it was a triggering situation,” he said.
“Instead of allowing that individual's feelings to fester over time leading to depression, anxiety, or a chronic stress disorder, they were able to provide an immediate intervention and develop a follow-up plan not just for the person but also for their family, which was really the source of stress for this doctor's situation,” said Dr Adibe.
2. Wellness Consult Service
If a physician or other health professional needs an evaluation, triage, or resource recommended for improving their mental health and well-being, a wellness consult allows them to connect directly with a member of the wellness team.
This consult service helps to normalize the concept of wellness by incorporating it more formally into the clinical environment. Group sessions are also available for entire units, departments, or clinical teams in need. All consults are anonymous and are never included in a care team member's medical record. When needed, individuals can page “2323” to reach a team member.
“The Wellness Consult Service provides both staff members and their managers the opportunity to immediately engage with the Wellness Response Team as issues escalate,” said Dr Adibe. “Pages range from individuals seeking immediate counseling to managers looking for support to manage burnout or anxiety among their staff.”
3. Wellness Plus
As a unit worked to adjust to the changing reality of the COVID-19 crisis, a manager used the consult service to escalate her growing concern about a care team member struggling to maintain her professionalism.
After the unit manager reached out to the consult service, the Wellness Response Team identified the need for immediate evaluation through the Wellness Plus pathway. This is an immediate, targeted response to individual employees who are in a mental health crisis.
In this situation, “a psychiatrist was immediately deployed who identified an interruption in the individual's medication,” said Dr Adibe. “This was promptly addressed and resulted in a significant improvement in well-being and morale for the unit leadership, the individual staff member, and other members of the clinical team.”
Through a predetermined escalation algorithm, any member from the Wellness Response Team can trigger the Wellness Plus pathway. When triggered, the individual in need is brought to the unit-level Wellness Rooms or central Wellness Resource Hub where an experienced physician completes a thorough mental health assessment.
4. Wellness resource hub and rooms
A 14-foot video projection of a waterfall with soothing music and healthy snacks greet employees as they enter the Wellness Resource Hub. The location is where any health professional can receive confidential on-site counseling support, escape busy clinical areas, process their emotions, and relax. These areas are managed by psychologists and licensed clinical social workers.
The Wellness Resource Hub is available for drop-ins anytime from 8 AM to 8 PM Monday through Friday. Frontline physicians and other health professionals who are unable to leave the unit have access to a network of Wellness Rooms throughout the medical center, with a special focus on high-volume COVID-19 intensive care units.
“Rooms include hand-written ‘thank you' cards from the community and supportive messaging encouraging our health care heroes,” said Dr Adibe.
5. Well-being after the pandemic
“The literature tells us that most likely over the next several months, up to even 12 months later, many people will begin to really feel some of the emotional impact of this,” said Dr Adibe. “Our job is to be prepared for that in advance and to mitigate some of the acute and chronic stress disorders that could happen if we weren't to act.”
To identify acute and chronic stress disorders, including post-traumatic stress disorder (PTSD), an advanced emotional well-being screening tool was developed. Originally designed for military personnel returning from deployment, this tool has been adapted for health care workers on the frontlines of the COVID-19 pandemic. In addition to a being used as a screening survey, the tool will recommend suggested therapies to help mitigate some of the risks.
“We want to make sure that those who need help can get it quickly, consistently, and without fear of stigma,” said Dr Adibe.