When COVID-19 struck New York City in early 2020, NYU Langone Medical Center was transformed. So was Dr. Katherine Hochman’s job as a hospitalist. Hear the way she faced challenges and created solutions for her hospital and her patients.
When COVID-19 struck New York City in early 2020, NYU Langone Medical Center was transformed. So was Dr. Katherine Hochman’s job as a hospitalist. Hear the way she faced challenges and created solutions for her hospital and her patients.
Vital Signs
By Sirius XM and NYU Langone Health
Season 2, Episode 5
Title: Who Is Free Right Now?
Description: When COVID-19 struck New York City in early 2020, NYU Langone Medical Center was transformed. So was Dr. Katherine Hochman’s job as a hospitalist. Hear the way she faced the challenges and created solutions for her hospital and her patients.
Participants: Katherine Hochman, Syed Hoda, Jennifer Stein, Rose Reid
Transcript:
Dr. Katherine Hochman: So we all knew COVID was coming. Since I've been here for 22 years, we've had other tragedies. But nothing compared to COVID. I'm the kind of person who is on the ground, kind of rolling up my sleeves and doing the work that I asked my team to do. It was a new kind of leadership challenge, which was not a comfortable place to be. And I was also scared for my own safety. I'm Dr. Katherine Hochman, the Division Director for Hospital Medicine at NYU Langone Health.
Narrator: When COVID struck New York City in the spring of 2020, NYU Langone Medical Center was full of sick patients, and overwhelmed providers caring for them. Outside the hospital, family members were desperate for information, which was in short supply. It didn’t take long for Dr. Katherine Hochman to connect the dots. And the people.
Dr. Hochman: it dawned on me this was not business as usual. In no time flat, we had over a hundred medical students, 65 radiologists. And then the dermatologists came. The urologists came. The orthopedic surgeons came.The pathologists came. All these groups of people. We had about 150 attending physicians from all different specialties come and want to help.
Transcript: From SiriusXM and NYU Langone Health, this is Vital Signs, where medicine is made personal. I’m your host, Rose Reid.
Narrator: Dr. Katherine Hochman is a hospitalist. The term first appeared in a 1996 article in the New England Journal of Medicine, and since then it has become the fastest growing specialty in the United States. There are currently around 50,000 hospitalists practicing medicine in the US. But early on at NYU, there was just one.
Dr. Hochman: Back in 2004, there was one person that was me. As a hospitalist, I took care of patients who didn't have primary care doctors. So at that time, that only constituted 5% of the patients. So it was my job to grow the program because I knew that if an internist stays in the hospital and is there to speak to the care manager and social worker and the family and have family meetings. These are things that, for the most part, my outpatient colleagues didn't really have that have the time to do. My job was to be in the hospital and to really be, you know, caring for these patients while they were here
Narrator: Dr. Hochman knew that if she was going to grow the hospitalist program at NYU Langone, she needed to show the value of hospitalists
Dr. Hochman: I've always loved numbers, and I knew the numbers were going to save me here, and the program. Because we were able to show hospitalist versus non hospitalist, our observed to expected length of stay, our readmission rate. Our quality metrics were all at least the same, if not much better than our outpatient colleagues. And that was an important revelation.
Narrator: It was important enough that Dr. Hochman knew she had to start speaking up.
Dr. Hochman: I needed to be able to justify new people in the program, and as we were gaining more patients, we needed more physicians to care for these patients. So I have to make an argument and my argument always came back down to the numbers. It's somewhat intimidating actually. Everybody asks you to justify why you want more people, and then you share the numbers. I felt like I earned my chops back then because, you know, many times I was the, certainly the youngest person at the table. Many times I was the only woman at the table. And I successfully was able to argue that we needed more and more people to grow the program. So very quickly the program grew. And I went from being just the first hospitalist. One person’s not a program. But very quickly, we had four. and then very quickly we doubled and we doubled again. And now we have 34 people in our program.
Narrator: Doctors are busy people, and hospitals are busy places. It can be easy to miss the forest for the trees. As Dr. Hochman grew into her role, and grew the hospitalist program at NYU Langone Health, she understood how her team could become an organizing force.
Dr. Hochman: So people were really just working in silos in the early days. You know, doctors were doing their thing. Nurses were doing their thing. Care managers and social workers, and there was really no team. There was no formal way of getting together. There was so much waste and I could see that being a first year attending here. Even as a resident, you could see all the, all the waste that was happening, not just in NYU, but all in all of medicine. Things like getting labs every day, you don't need that necessarily. Or have a conversation with a patient about what he or she wants and then guide your therapies based on what the patient wants, not based on what you want. And a lot of the waste came from, you know, inefficient structure on rounds. We put structure in. This was with a lot of very smart people working with me, um, to help create a structure around teamwork. So that now if you were to go up to any of the medicine wards, it's almost 9:30 now, okay. At about 20 minutes or so, you will have all the doctors and nurses and the care managers and social workers and the physical therapists all in a huddle. And they will be talking about each and every patient. All the patients who have hotspots, people who have, uh, different lines and tubes and who's in pain and who's refusing their VTE prophylaxis. All this is ready to go. What I always tell my team is to go into huddle you have to be on your A game. You can't waffle into huddle and not know what's happening with your patient. You may not have the diagnosis cinched at that point, but you have to have a plan to get that diagnosis cinched. Because, you know, your patient’s in the hospital, they don't want to be here. You have an obligation to find their diagnosis, and get them treated expeditiously and, and properly. And I always tell my team here, you have to slow down to speed up. That's important. So when you sit down with your patient for the first time, it really matters how you introduce yourself. You know, you really have to say, Hi, I'm Dr. Hochman. I'm the attending physician. I'm going to be the one looking after you. I'm so happy to be doing so. You have to be able to create connections, create trust in a very short amount of time. So you can do that simply by saying, I've spoken with your primary care doctor and let him or her know you're here. Now, medicine changes so quick, by the time you leave huddle, maybe things have changed, but at least for that moment, we're on the same page.
Narrator: Dr. Hochman and her colleagues developed what is known as a system. A hospital is a hospital of course, a place where people go when they’re sick, or if they need surgery, or to give birth. It’s also a place full of systems. And some work better than others. Recognizing if and why a system works, or where a new system is needed is another critical job of a hospitalist.
Dr. Hochman: The hospitalists in addition to taking great care of patients are very much into systems thinking, quality improvement in the hospital, patient safety in the hospital. We are, as part of a definition of a hospitalist if you will, stewards of the hospital. It's our job to make sure that this wonderful hospital, that we're a part of this wonderful hospital system, that we're a part of that we're, we're using these resources wisely. And that doesn't mean we're trying to be stingy with patients who come in. But we want to make sure that the right test is done. And if that right test is an expensive MRI, then we're going to do it. But if the same information can be obtained by a CT scan, well, we should do that. We are stewards of the hospital and we have to care for the hospital, just like we care for our patients. And that means really taking inventory of what works well and what doesn't work well, sometimes. So all of my hospitalists and I, we are always on the scout out for things that maybe are not working well.
Narrator: In some instances, that can mean turning yourself in.
Dr. Hochman: So a few years back, a resident put in it's called a PSI. So it's a patient safety indicator. Basically it’s a mechanism that you enter in to the computer if something isn't working well, and it raises attention. So this person had the courage to put in a PSI on himself. And what he did in error was that he discharged a patient on oral antibiotics, but with a PICC line. So PICC line is for patients who require intravenous antibiotics. You should never discharge a patient with a PICC line if you're giving them oral antibiotics. So this was a mistake. This was a big no-no. But he had the courage to put a PSI on himself. So this raised a lot of awareness. And again, this is a no blame culture. So my first reaction towards him was thank you. You did such a brave thing. And we realized that we were putting in PICC lines on way too many people. It wasn't just this person. It was just way too many people. This led to a big quality improvement initiative, where we created a big educational campaign. And to cut a long story short, we reduced the number of PICC lines by about 70%. And with that, we reduced the number of PICC line days by about the same amount, 70%. And we reduced our infections and et cetera, et cetera. So this was a fantastic outcome from somebody who again, had the gumption to make himself vulnerable. So we're all about that. That’s a prime example. So if you have a bunch of eyes and ears on the ground and everyone's putting in PSIs, well, that's caring for your hospital system and that's very important. And that's what hospital medicine is all about.
Narrator: Hospitals prepare for, and often simulate, catastrophic events. In part to test how the systems in place will hold up during an emergency. As a practicing physician at a busy New York City hospital, Dr. Hochman has experienced her own share of actual emergencies.
Dr. Hochman: I've been here for 22 years, we've had other tragedies. I remember being in the cardiac care unit in Bellevue. And I happened to be on call on September 10th, overnight. So now you're onto September 11th, which we all know is a beautiful Tuesday morning.
News footage: It’s early this tuesday morning, the 11th of september, 2001.
Dr. Hochman: And I was with my wonderful attending. I'll never forget him, Dr. Rich Levin. And we started making rounds. And you start on bed one, and then you go to the end. And by the time we got to bed four, the interns noticed that that plane had flown into the Trade Center.
News footage: Breaking news story to tell you about. Apparently a plane has just crashed into the World Trade Center here in New York City. It happened just a few moments ago.
Dr. Hochman: So that, so that was obviously, you know, a terrible time.
News Footage: It was devastating as it unfolded. But only now, hours later, under the harsh lights of rescue vehicles, is the true, horrifying breadth of the teror becoming clear. Before it is over, the casualty numbers will be numbing. And few in the city will be untouched by what happened today.
Dr. Hochman: Fast forward. We had a mini, you know, worry with Hurricane Irene.
News footage: We are witnessing history. Rarely before has a hurricane barrelled forward with so many major American cities in her path.
Dr. Hochman: That was in 2011 when we actually evacuated everything.
News footage: We are today issuing a mandatory evacuation order for all New Yorkers that are at greatest risk of damage relating to Irene.
Dr. Hochman: And then the next year we had Hurricane Sandy and we decided, Oh, let's shelter in place.
News footage: Sandy brings potentially an extra 6 to 12 feet of sea and river flow that could fill low lying areas of Manhattan like a basement.
Dr. Hochman: And that was a different leadership challenge because we were closed, I had to move my team out to many other local hospitals. Uh, so that was a different kind of challenge. So the point is we've had these crazy challenges, um, but nothing compared to COVID.
News Footage: Breaking news tonight. The US reaching another grim milestone. Deaths in the US now well over 3000. The toll now higher than the 9/11 attacks. In New York City, a sea of ambulances arriving. Medical workers rushing to the epicenter. Doctors and nurses being infected themselves - over 200 in the city. The growing crisis on the front lines.
Narrator: NYU Langone Medical Center - the hospital where Dr. Hochman has practiced medicine for her entire career, the place she looks after as a devoted hospitalist - was transformed in the earliest days of the pandemic.
Dr. Hochman: So we all knew COVID was coming. So, you know, I remember, uh, this must've been in early March, before we had our first case, maybe late February, where I had, uh, Dr. Mike Phillips, who's our chief epidemiologist. I wanted him to come up and show us how to appropriately don and doff PPE. We were sort of waiting for the storm. And then, you know, when the first case hit, it was that first case where we were all ready to go. And so that first patient came, and I remember the first hospitalist who happened to be on the wards on KP12, Dr. Ravi Kesari. He was the first one up. So he cared for our first patient. And at the time, you know, we didn't have good testing. So a patient would come here and wait forever and ever, and ever, and we couldn't get the test back. So we suspected COVID, but we didn't really know for several days. So these numbers of patients who came in with respiratory illness grew and grew and grew. Before long, we had basically converted the entire hospital into a COVID hospital. There were no other diagnoses being admitted.
Narrator: By the first week of April in 2020, NYU Langone’s hospital system was admitting an average of 180 new COVID19 patients each day. These patients demanded the attention of her entire team, and then some. It was scary, and new, and consuming. Dr. Hochman and the other hospitalists worked around the clock on the front lines to save lives - sometimes, at their own expense.
Dr. Hochman: I remember I was on a call. I was in the middle of a two week stretch in the end of March. And, you know, I sort of had this nagging cough, and I was very tired. And, um, you know, it was my husband who said, you know, Kathy, are you sure you don't have COVID? I said, no, I'm, I'm, I'm just tired. You know, I'm like, we're exhausted, we're stressed. But of course I had that nagging thought in the back of my head. So I had finished seeing patients and we were all gowned up. We, you know, we were taking it very seriously. But I went and got a COVID test. And this was, um, this was Sunday, I think, the 22nd of March. And I, you know, I was expecting it to be negative and to race back into the work the next day. Sure enough, it was positive. And that was a big sort of aha moment for me and my family. I felt, okay. I had a cough, a lingering cough that stayed for weeks, frankly. I didn't have a fever and I was never, you know, short of oxygen and thankfully, but that took me out of commission.
Narrator: If it isn’t clear by now - Dr. Katherine Hochman is an in-the-mix, hands-on leader, the kind of general who directs the troops but also goes right into battle with them. Sitting still is not her strong suit.
Dr. Hochman: It was a new kind of leadership challenge where I was sort of, I dunno, leading from my bedroom quarantine, if you will. Which was not a comfortable place to be. And I was also scared for my own safety. And then I had such guilt about possibly having infected my family, my colleagues, and the other patients who I was seeing. So, you know, there was a lot of, a lot of that wrapped up. I think what helped me kind of get out of my COVID doldrums, if you will, was work, you know, so I did not spend any of that bedroom, quarantine, you know, binging on Netflix or anything like that. In fact, I don't think I even turned on the TV once. I kept a diary. But what, what really helped me was - what the heck can I do in my bedroom quarantine that can help out my team?
Narrator: Her options were limited. But even as much of the hospital staff was inundated with COVID patients, others were left with much less to do
Dr. Hochman: It dawned on me that this was not business as usual. Elective surgeries had stopped by governor ordinance. And there were pockets of people who were desperate to help.
Narrator: Doctors and nurses on the COVID wards had a lot of patients, and not a lot of time.
Dr. Hochman: They were absolutely overwhelmed, caring for patients. I knew that they were really struggling calling the families of the patients who they were seeing. So I thought, okay, how are we going to do this? You know, there's a problem. Patients, families are desperate for information and the teams have absolutely no capacity to call. So, okay. Thought for a second who is free right now? Who has, who has the capacity to work?
Narrator: Elective surgeries were suspended. Other specialists who did not provide direct COVID care also had their schedules reduced, shifted to telehealth, or paused. Medical students were sent home from the hospital for their own safety, and attended classes remotely. Many people who had been really busy at the hospital before COVID hit were all suddenly sidelined - during the biggest health crisis of the last 100 years.
Dr. Hochman: In no time at all, I got in touch with the head of radiology and in literally half a day, I had 65 attending radiologists wanting and desperate to be able to call families and to get into this program that we called NYU Family Connect. And our vision was that the family members of every single COVID-19 patient would receive a proactive daily call from medical professionals who could give a real update on what was happening from the team's perspective. In addition to those 65 wonderful radiologists, I, um, was able to get in touch with the medical students. And they were desperate to help. So in no time flat, we had over a hundred medical students matched up with these 65 radiologists. And then the dermatologists came, the urologists came, the orthopedic surgeons came, the pathologists came. All these groups of people. We had about 150 attending physicians from all different specialties come and, and want to help. So what I did was I paired up one medical student with one attending physician. And we trained these groups of people about how to look at the medical record, because this was all going to be a remote activity. What pieces of information were important to extract from the medical chart?And these were things like, you know, how much stuff that the patient's families want to know. How much oxygen is this patient on? Does this person have a fever? What is the medical plan like? Are they getting all these different therapies? Are they going to move to a less intense unit? Are they about to go home? You know, remember radiologists and pathologists don't always talk to patients, but they wanted to learn. And this is why this medical center is so outstanding. So they did a chart review, number one, and then number two, we thought it was so important that they give accurate information. We created a system whereby they would call into rounds so they could hear what was happening with every patient. And the team was more than happy to give them the information because then they were able to focus on patient care and the family connect team was able to make the calls to the families.
Dr. Jennifer Stein: My name is Jennifer Stein and I'm a professor of dermatology at NYU Langone. And I was a member of the Family Connect program from the beginning of the pandemic for about six weeks.
Dr. Syed Hoda: My name is Dr. Syed Hoda from NYU's Department of Pathology. I'm the director of bone and soft tissue pathology here. And I was, uh, involved with Family Connect in the late winter of 2020.
Narrator: When Dr. Stein and Dr. Hoda volunteered for Family Connect, they had little in common as physicians. Dr. Stein is part of a busy practice at NYU, interfacing with patients all day long. As a pathologist, Dr. Hoda is more behind-the-scenes, helping his clinical colleagues diagnose and treat patients by studying tissue samples.
Dr. Hoda: When the lockdown started, our work had gone drastically downhill in terms of volume as the surgical rooms closed. So I decided to send some emails out, trying to volunteer myself for different roles in the hospital, in the ICU or in the internal medicine floors or wherever, ER. And my vice chair had received an email from Dr. Hochman that she was starting a new project to help families out. I was instantly sold. I recall sitting in my car the first day before we started the service, nervous as if I'm being like launched into Mars.
Narrator: Dr. Stein wasn’t sure what to expect from Family Connect either. But she knew what to expect from its leader.
Dr. Stein: When I was a medical student, I always loved and admired Kathy Hochman. I learned so from her, I learned how to do a physical exam with a patient from Kathy Hochman. And when I heard about the pandemic, as the pandemic was getting more and more serious, I was thinking about her and about so many colleagues and friends that I had in the medicine department. I wanted to help very much, and I didn't know how I could actually make a difference
Narrator: Once it became clear how they could help, Drs. Hoda and Stein did their best to serve patients and their loved ones through Family Connect. In many ways, it was unlike anything either of them had done before.
Dr. Hoda: Often you'd get the same families and same patients for several days in a row. So you ended up forming kind of a bond with some of the family people that you'd talk to every day. And usually it was the same family member who wanted to talk and continue the conversation. So one, one of the patients, the husband was in the hospital, the wife was at home, and he was not doing well. But when he was getting a bit more awake, he was very confused and I was told by the ICU staff that he was very oriented and felt kind of agitated. So I remember speaking to the wife and she said that he needs his glasses. I don't think he has his glasses. As somebody who wears glasses, I know that if I don't have my glasses, I would probably go wild. I don't think I would be able to function properly. And I started imagining if I was in that room and I didn't have my glasses. And I was just, you know, coming to awake from being kind of like asleep for a while. I would be really agitated as well. So it became really a primary goal to get him these glasses. it wasn't so easy because it was such a chaotic time then in the ICU to, to make sure that these pair of glasses can get to him. She was very, very, grateful of the effort it took to get it done.
(music)
Dr. Hoda: I am a very, very subspecialized, type of doctor. There's less than a hundred or so practicing in the US who train the way I am. I don't interact the way Dr. Hochman interacts day to day with all types of patients, like I don’t. And we all had a deep appreciation of the small details that you kind of take for granted. Like in my work day to day, I am not considering does this patient have glasses? But Dr. Hochman's project created a group of people who were from all different expertises who kind of joined at a baseline of where we needed to be, to function and to help people. We are doctors first, before we are specialists. But before that, we're actually people first before we're even doctors.
Dr. Stein: In the beginning there was so much conflicting information and patient’s family members were hearing about various treatment options. And they wanted everything possible done for their family members. Of course, sometimes there weren't great answers to be able to share with the family members, which of course was very stressful, but that was just part of the nature of this pandemic. And as a dermatologist, sometimes I didn't know the answer. So what I would tell them is I would get, I would learn about, I would try to get the information from the healthcare workers who were taking care of their family members and get back to them. I mean, that’s the nature of medicine is that your every day is somebody's worst day of their life.
Dr. Stein: One of the most difficult phone calls I had was there was a patient who was new to the unit and the team actually was feeling very optimistic about him. I always wanted to be able to give good news. And you wanna give people something to cling to, some hope to cling to, when they're feeling devastated and they're so worried about their family member. So I remember I called the patient's family and I said, don't worry. The team says he's the healthiest patient in the ICU, they’re not that worried about him. It's going to be okay. And this was right before I went to sleep, and the next morning I opened up the chart and I saw he was intubated and things looked really bad. And I remember being so afraid to call the family because I knew they were gonna say, you said everything was okay. How did this happen? Um, and I think that was an important lesson, which is trying to figure out the right amount of hope to give a family, but not promising them too much. Just because it's easier to give people good news than bad news. And I think that's a very difficult balance.
(music)
Dr. Stein: I think the pandemic has forced us to be a lot more agile. I think it's forced us to be prepared for change. It's forced us to be prepared for unexpected experiences. When something comes up that you weren't planning - to be able to look at the situation the way it is right now, to pull in all the information that you have available to you right now, and just make the best decision that you can. And to keep reevaluating those decisions as the environment around you is changing. As the information you're getting is changing, to be able to change your plan quickly and to keep your eye on patient care and safety to make the right decisions.
Narrator: When ideas are really good, they can seem obvious in retrospect. Of course it made sense for medical students and specialists to pitch in however, wherever, whenever. Harnessing their knowledge - to help patients and families stay connected - led to the launch of Family Connect. What might not be so obvious is how to organize all of those people into a system that could work efficiently. Dr. Hochman has built her career around developing and refining systems inside of a hospital. And that’s exactly what she did - even when she was temporarily not allowed inside that hospital. And while COVID was unpredictable at nearly every turn, there was one thing that never surprised Dr. Hochman.
Dr. Hochman: I have to say it was really heartwarming to see the waves of people come and sign up for this program and, and clamor. I got hammered with emails from people, please let me into this program. At the end of the day? I wasn't surprised because this is NYU. That's what we do, but it was just so encouraging and loving to see it.
Narrator: None of us would have ever wished this pandemic into our lives. It has been a rolling, devastating, human tragedy - that has also been a catalyst for innovation. Medicine has advanced - sometimes at warp speed - in enormous, profound ways. And slowly, in smaller ones. For a few weeks, in the spring of 2020, at the first peak of the first wave in the first COVID epicenter in the United States, a group of doctors and medical students got together and made a difference in the lives of COVID patients and their loved ones. It was a gift to these families during a terrifying time. It was also an opportunity to learn, and grow.
Dr. Hochman: Some of the medical students spent hours on the phone with families. They got really deep into the family connection, multiple multiple calls a day. We did a little survey for the medical students who had participated in the program and the grand majority described this initiative as one that was a transforming initiative in their medical education. And that was a very proud moment for me because I know how tough the medical students are when it comes to their medical education and what they feel is valuable. And this was a real life experience and they really needed to get it right. And they crushed it. They were outstanding, they took it so seriously. They delivered very timely information. And if they didn't know the answer, they would clarify that with a team and get back to the family. So the families were very appreciative of that as well. And not only were the families appreciative, but we also surveyed the frontline teams. They were incredibly appreciative because then that took the burden off of them when it came to calling the families, but they knew that the families were being informed. Uh, so overall, it was sort of a win, win, win for everybody
Narrator: In medicine, in a pandemic, you take the wins where you can get them. It has been two years since the pandemic began, since Dr. Katherine Hochman got COVID, since she organized Family Connect. The program was brief but powerful, and a shining example of how - and why - she leads. Ernest Hemingway said that people are often “strong at the broken places.” Hospitals can be too. That resident who bravely exposed his own mistake led to a major change - and improvement - in how NYU Langone Health cares for its patients. The horrors of the pandemic created a situation where new and seasoned healthcare professionals could work together, become better communicators, and help families through a frightening time.
Dr. Hochman: You know, showing a vulnerability is a strength. I think you have to be willing to fail and to fail royally. Like, really mess it up. And really put yourself out there and do your best and just flunk. And you will learn and grow much more than if you sort of say, stay in your safe zone.
Narrator: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Julie Kanfer, and Keith King, with sound design by Jim Bilodeau and writing from Julie Kanfer. SiriusXM’s executive producer is Beth Ameen, in partnership with Allison Clair and Jim Mandler of NYU Langone Health. Don’t miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone Health, tune into Doctor Radio on SiriusXM channel 110. Or listen anytime on the SXM app. To get in touch with our production team, email VitalSigns@siriusxm.com. For the Vital Signs podcast, I’m Rose Reid. Join us next time as we bring you stories of medicine made personal.