ER doc and healthcare systems engineer discusses caring for the ‘COVID convalescent’
David Adinaro

Interview by Katie Kackenmeister

Dr. David Adinaro ’88 ’15 M.Eng. was recently named deputy commissioner for public health services for New Jersey’s Department of Health. An emergency medicine physician and alumnus of Lehigh’s Healthcare Systems Engineering graduate program, Adinaro was tapped for this role after answering the call to lead the NJ Field Medical Station-Secaucus at the Meadowlands in the early months of the pandemic. As its chief medical officer (CMO), Adinaro guided the convention-center-turned-field-hospital and its volunteer medical staff in its mission to care for recovering COVID-19 patients while taking stress off of hospitals. Prior to his public service, Adinaro held numerous positions, including chief of emergency medicine, chief medical information officer, and vice president and CMO, over his 17-year career as a physician at New Jersey’s St. Joseph’s University Medical Center.

Dr. Adinaro’s led the field hospital medical operations at the Meadowlands Exposition Center in New Jersey, including over 250 cubicles created and designed to serve as patient rooms. (Photo courtesy David Adinaro)

Q: How did the field hospital get started?

A: When I arrived at the Meadowlands Exposition Center, 250 cubicles had been erected to serve as patient rooms. Over the next eight days, and with support from the state’s National Guard, Office of Emergency Management, and additional partners, we found staff, got radiology and lab support, and gathered all the equipment you need to be a stripped-down community hospital.

At the beginning, we were tasked with creating a facility for non-COVID patients because the hospitals were overwhelmed. But by the time we were up and running on April 8, there were almost no non-COVID patients in hospitals. So, we switched gears to focus on the “COVID convalescing”—people in the final three to seven days of their hospital stay.

Nearly all of our patients required oxygen, and setting that up was a bit of an engineering feat. Hospitals have sophisticated medical gas systems and big tanks of liquid oxygen. We had to supply our oxygen through many heavy, smaller steel tanks. I worked with the respiratory therapist to calculate how much oxygen we needed on a daily basis and what that translated to in terms of portable tanks. And by portable, I mean they weigh 140 pounds each! Also, how much tubing? How many regulators and mutilators? There was a little bit of engineering and a lot of math, which is not a normal CMO type of thing.

Q: Could you describe your team and what it was like working there?

A: At the time, there weren’t a lot of elective surgeries going on, so those doctors joined our staff. For example, we had a plastic surgeon, a husband-and-wife pediatrician-and-spine-surgeon combo, and a vascular surgeon who does outpatient vein procedures. A 25-person medical contingent of New Jersey Army and Air National Guard personnel was also key to our initial success. There were many physician assistants and advanced-practice nurses, but none of these people had been practicing hospital-based medicine just a few weeks prior.

David Adinaro

Dr. Adinaro’s training as a physician, administrator, and systems engineer prepared him for the challenges of leading the medical operations at the expo center. (Photo courtesy David Adinaro)

It was an austere environment. People working with patients wore scrubs, plus an impregnable gown, a N95 mask, a surgical mask, and an eye shield, for 11 hours of a 12-hour shift. You’d sit on metal chairs with tables like you’d have at a picnic. You were working on paper. The patient rooms were 10-by-10 cubicles with a curtain. They had electricity, a lamp, a camp bed, pretty good Wi-Fi, another chair, and a little table. It was designed to be temporary, and in May, with the “curve” of cases improving, the entire operation moved to a former acute rehabilitation hospital in East Orange. Fortunately, no patients are currently there, but it is ready to be reactivated within days should a second wave of patients occur.

Q: How would you characterize your specific role as CMO?

A: In Secaucus, we were practicing least-common-denominator, commonsense medicine. But there are some things you just have to do right. We had to be prepared for a medical emergency. We required a lot of PPE [personal protective equipment] to keep everybody safe. And we also needed to have procedures in place if a staff member were to get sick.

As CMO, I was in charge of provider relations, screening of the physicians, troubleshooting, and any patient care issues that came up. I worked with the physicians to establish a cohesive approach. I also spent a lot of time interacting with the National Guard command and the Department of Health, coordinating with the acute care hospitals and deciding which patients we could accept.

Q: How did your medical experience prepare you for this job?

A: Having been an emergency physician for a long time, I’m used to a less well-defined environment. I also have a background in large projects. The challenge was that we were operating with few people in an extremely short period of time and had to make decisions in days, not months. But having project management expertise, knowing how to work with people from different backgrounds, being familiar with the state police and their resources, and understanding the bare minimum needed to run a hospital all prepared me for this role.

Medical staff transfer a patient to one of the critical care rooms at the expo center. (Photo courtesy David Adinaro)

Q: Where did your engineering background tie in?

A: A lot of what I was doing was pure engineering or troubleshooting on the systems side. I was constantly figuring out where the rate-limiting steps were. Getting the hospitals to know what patients we’d take. Then arranging for the patients to show up, and making sure they weren’t all arriving at the same time. And then, how would we get them home again? These were all steps in the system, and if there were a failure at any point, it would back up everybody else in the flow. I had to engineer the systems and figure out how to safely get to the easiest, fewest number of steps possible.

We needed to make it easy for the hospitals, which were bursting at the seams with people in danger of dying. If I’d asked for a complete medical record on every single patient before we’d even talk to them, they’d never send me a patient. We needed to unburden the hospitals safely with a properly trained team of professionals.

I will always feel like I’m not doing enough unless I’m in the absolute chaos of the ER. But by getting as many patients as we could out of these hospitals, we were making it possible for doctors and nurses to have better patient ratios, so they could focus on the sicker patients. And these convalescing patients received a level of attention that would have been impossible in the overwhelmed acute care hospitals.

Q: Why is a systems engineering mindset important in your field?

A: Compared with other industries like manufacturing or retail, health care is probably a generation behind when it comes to taking a systematic, technology-driven, data-analytics approach to decision-making. Obviously in health care, you’re not making a widget and you don’t always know what the individual patient’s journey is going to be, so it’s incredibly dynamic. My experience in Lehigh’s Healthcare Systems Engineering program made me far better at understanding the interrelationship of parts within a complex system and applying the principles of optimization. And just like medical school made me think like a doctor, going through the HSE program changed my brain and made me think like an engineer.