Leading with Empathy in Times of Uncertainty

June 15, 2020

Hanger Clinic

Serving on the front lines during a pandemic is unimaginable for many of us, especially in one of the hardest-hit communities in the nation–the Bronx, New York. With amputations on the rise and uncertainty at an all-time high, how one Hanger Clinic team responded demonstrated resilience, dedication, and compassion at a time when our patients and partners needed it most.

The Bronx is known for being one of the most lively boroughs in New York City. Home to Yankee Stadium, the Bronx Zoo, and the New York Botanical Gardens, the Bronx is full of cultural institutions that attract millions of visitors each year. It’s also home to one of the most diverse and densely-populated areas in the country, making it a prime target for the novel coronavirus to quickly take hold.

With more than 40,000 Bronx residents testing positive for COVID-19, the hospitals were quickly overrun, and among the busiest was Montefiore Medical Center. The lack of ventilators and personal protective equipment (PPE) was a highly-publicized concern as the pandemic began to take off, but doctors and nurses selflessly stepped up to risk their lives in order to save the lives of others.

What was not as well-known was the ripple effect the virus had on infected patients’ health and well-being. “For reasons that are not exactly clear at this time but are being looked into, some patients with COVID-19 experienced arterial and venous clotting more than those in the regular population,” said Amy Wisnewski, MHS, PA-C, Surgical Physician Assistant in the Montefiore Department of Cardiothoracic and Vascular Surgery. “This, unfortunately, resulted in an increase in amputations. And as the virus continued its hold on our community, I started to worry about how we would get the necessary equipment to patients in this uncertain environment.”

Stepping onto the Front Lines

The Bronx Hanger Clinic team knew they needed to see these patients, but with the virus spreading rapidly and hospital policies and procedures changing by the minute, the question was how.

The answer was three-fold: communication, timeliness, and empathy–all elements of the Hanger Clinic Patient Experience.

The Hanger Clinic team kept the lines of communication open with the medical team at Montefiore to ensure they were up to date on the latest hospital safety rules and guidelines. They also committed to serving with open hearts and open minds, so all patients, including those infected with COVID-19, could still get access to the best post-operative care possible, even in the midst of all the chaos.

The primary goal during this time was to safely discharge medically-ready patients as quickly as possible to limit their exposure to the virus. In order to accomplish this, patients needed to be fit with AmpuShield limb protectors and offloading shoes faster than they normally would, requiring both teams to quickly pivot and adjust their workflow to help ensure safety and efficiency.

“For COVID-19 positive patients, members of our team would provide the limb measurements directly to the prosthetist at Hanger Clinic to help reduce exposures,” Amy said. “There was constant communication about sending orders, when patients would be ready for fitting, and discharge planning to coordinate timely fitting and delivery. I am very appreciative to all the members of the Bronx Hanger Clinic team who supported us, came to physically see our patients and deliver supplies, and provided support to them and us virtually.”

Caring for the Mind, Body, and Soul

If there is anything Hanger Clinic teams know all too well, it’s that rehabilitating limb loss patients doesn’t begin and end with physical care. It’s a lifelong journey throughout which mental health plays an extremely critical role, one that is only heightened after overcoming a life-threatening illness like the coronavirus and being forced to recover in the midst of a lockdown.

According to Matthew Johnson, NY Metro Regional Director for Hanger Clinic, “Throughout the pandemic, we worked hard to ensure our Community Care Coordinator was still meeting with every patient virtually. We went into it with the mindset that every touch point is that much more important since we’re not able to see people in person.”

The role of a Community Care Coordinator at Hanger Clinic is unique in that it exists solely for the purpose of helping new limb loss patients and families through this difficult time. It is a complimentary service that supports the clinical care provided by Hanger Clinic’s certified clinicians and is aligned with the goal of enhancing the patient experience. They help with navigating the often overwhelming process, providing access to peer support, and coordinating clinically-supported post-operative care protocols, including limb volume management and limb protection.

Quite a few of Hanger Clinic’s Community Care Coordinators across the country are amputees themselves, giving them first-hand experience with what patients are going through. Robert Rodriguez, a below-knee amputee and member of the Bronx care team, is one of them.

According to Amy at Montefiore, Robert went above and beyond in an effort to stay connected with patients, even when the hospital was limiting visitors: “Robert was able to call patients in their hospital room and answer their questions while providing them the perspective of someone who has been on the patient side. I have noticed that patients who are willing to speak with a peer mentor feel much more comfortable and assured about their situation and what comes next, and I am so thankful that it has continued even throughout this pandemic, especially since patients cannot have their loved ones with them during such a stressful time.”

Robert is also facilitating recurring Virtual AMPOWER Amputee Support Groups to help people with limb loss stay connected as New York City continues to practice social distancing.

A New Way Forward

As shelter-in-place and stay-at-home orders are lifted, many aspects of our “new normal” will likely stay intact.

Amy at Montefiore believes open, timely communication will continue to play a critical role in ensuring efficient and effective post-operative care, and that initiating peer support visits over the phone will continue to be helpful as patients recover from surgery and prepare for the journey ahead.

Matthew from Hanger Clinic believes many of the virtual aspects of care will stick around: virtual consultations, collaborative telehealth visits that bring the patient together with their broader care team, and electronic documentation to name a few.

We don’t know for sure what our world will look like three, six, or even 12 months from now. What we do know is that we’ve laid a solid foundation for patients to continue to receive the best possible orthotic and prosthetic care, whether it’s in the hospital, at the clinic, or from the comfort of home.